Update on the diagnostic radiologist shortage

The Undermined ACGME Subcompetency: A Roadmap for Radiology Residency Programs to Foster Residents-as-Educators

Radiology Residency programs in the United States use a set of six core competencies as laid out by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate the foundational skills of every resident. Despite the fact that educational skills are included under the heading of Practice-Based Learning and Improvement in the ACGME guidelines for radiology residents, it is often underappreciated and undervalued, when compared with medical knowledge or patient care. In this paper, the authors lay out the important role of residents-as-educators and how it can be inculcated as part of formal training during residency. They enunciate five pillars for academic programs to build and maintain the pedagogical skills of their radiology residents: Training, Practicing, Providing Feedback, Mentoring, and Changing the Culture. The authors believe that implementing this will holistically benefit radiology residents as well as radiology in building future educators. The authors also delineate the challenges that programs currently face in implementation and ways to overcome them.

The Development of an Automatic Rib Sequence Labeling System on Axial Computed Tomography Images with 3-Dimensional Region Growing

This paper proposes a development of automatic rib sequence labeling systems on chest computed tomography (CT) images with two suggested methods and three-dimensional (3D) region growing. In clinical practice, radiologists usually define anatomical terms of location depending on the rib’s number. Thus, with the manual process of labeling 12 pairs of ribs and counting their sequence, it is necessary to refer to the annotations every time the radiologists read chest CT. However, the process is tedious, repetitive, and time-consuming as the demand for chest CT-based medical readings has increased. To handle the task efficiently, we proposed an automatic rib sequence labeling system and implemented comparison analysis on two methods. With 50 collected chest CT images, we implemented intensity-based image processing (IIP) and a convolutional neural network (CNN) for rib segmentation on this system. Additionally, three-dimensional (3D) region growing was used to classify each rib’s label and put in a sequence label. The IIP-based method reported a 92.0% and the CNN-based method reported a 98.0% success rate, which is the rate of labeling appropriate rib sequences over whole pairs (1st to 12th) for all slices. We hope for the applicability thereof in clinical diagnostic environments by this method-efficient automatic rib sequence labeling system.

Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets

RATIONALE AND OBJECTIVES

There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign.

MATERIALS AND METHODS

We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees.

RESULTS

Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand.

CONCLUSIONS

The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply.

Work and retirement preferences of practicing radiologists as a predictor of workforce needs

RATIONALE AND OBJECTIVES

The radiology job market has been described as highly variable, and recent practice hiring surveys predict that the number of available jobs will remain flat. Radiologists may be working more hours and retiring later than desired, activities that influence overall job availability. A national survey was performed to determine the desired work rate and retirement preferences of practicing radiologists, and the responses are used to estimate current and potential future work output and future workforce needs.

MATERIALS AND METHODS

Practicing radiologists were surveyed regarding current and preferred work level and desired and expected retirement age. A model incorporating these preferences and stratified by age was developed using survey responses and American Medical Association full-time equivalent (FTE) estimates. Available FTE radiologists are estimated under four scenarios from 2016 to 2031 in 5-year intervals.

RESULTS

The model predicts a total of 26,362 FTE radiologists available in 2011, which corresponds to previous estimates. Participants reported working more hours and expecting to retire later than desired, with younger radiologists and women reporting the greatest desired decrease in FTE hours worked. Under each scenario, there is an initial FTE availability in 2016 ranging from 21,156 to 24,537, which increases to between 27,753 and 31,435 FTE by 2031 depending on work rate and retirement patterns.

CONCLUSIONS

Practicing radiologists report that they currently work more hours than desired and expect to retire later than they would prefer. If radiologists changed current personal work rate and expected retirement age to meet these preferences, there would be an immediate shortage of FTE radiologists continuing until at least 2020 assuming no other workforce needs changes.

Exposure to, understanding of, and interest in interventional radiology in American medical students

RATIONALE AND OBJECTIVES

The purposes of this study were to determine the degree to which medical students are exposed to interventional radiology (IR) in medical school, to assess their knowledge of the field, and to gauge their interest in IR as a career choice.

MATERIALS AND METHODS

An institutional review board-approved survey was generated using the website www.surveymonkey.com. Medical student participation nationwide was elicited by sending e-mails to administrators of medical schools and radiology residency program directors and asking them to distribute the survey link to their students.

RESULTS

Seven hundred twenty-nine medical students from 21 states responded to the survey. Although 58% of students said they were interested in a hands-on career, only 5.5% of students said they had participated in an IR rotation and only 12.7% were interested in IR. Less than half of the IR domain-related questions used to assess understanding of IR were answered correctly, with greater understanding found among the students who had participated in an IR rotation.

CONCLUSIONS

Exposure to IR in accredited US medical education programs is inconsistent, although interest in the field is moderate among medical students compared with interest in other hands-on specialties. Understanding of IR is limited among the study population. Improved understanding of the field and recruitment could result from greater exposure.

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.

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.

Buy-sell options for radiology: what works and why

Buy-sell agreements for shareholders entering and leaving a radiology practice are different from those commonly used in other business endeavors. This paper explores the reasons for these differences, focusing on the culture of radiology and its unique influence on the buy-sell process. Buy-sell methodologies commonly used in most business transactions are described, and basic principles that influence these methodologies are discussed. The reasons these traditional methods are not applicable to most radiology groups are explored in depth. The paper concludes with a presentation of several workable buy-sell options for radiology practices. The strengths and weaknesses of these options are enumerated, so that each group can customize the option that best suits its needs.

Ensuring the radiologist workforce: opportunities during education

The authors conducted a literature review to better understand the current trends in the medical workforce and, specifically, the effect these have had in radiology. The cyclic nature of the radiology workforce supply has paralleled similar experiences in the general medical profession and other specialties. A review of proven education and training initiatives demonstrates positive workforce effects in particular circumstances. The adaptation of proven education initiatives should enhance the future radiology workforce in both private and academic settings.

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.

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.

How Could the Radiologist Shortage Have Eased?

OBJECTIVE

In 2000, a severe shortage of diagnostic radiologists existed in the United States. We seek to explain how the shortage eased greatly by 2003, despite the fact that the total imaging workload usually grows much faster than the number of radiologists in practice, which would be expected to intensify the shortage.

MATERIALS AND METHODS

We measured the contribution of eight possible explanations, predominantly using simple quantitative analyses. We analyzed published data, data on the volume of imaging from Medicare and from the Medical Expenditure Panel Survey, data on residents and fellows from the American College of Radiology's (ACR) membership department, data on residents from the American Board of Radiology, data from the ACR's 1995 and 2003 Surveys of Radiologists, and data from interviews about nighthawk services.

RESULTS

From these data sources, we determined the following. Total imaging and imaging by radiologists continued to grow rapidly--by > 20% from 2000 to 2003 (measured in relative value units), which was somewhat faster than in the years preceding 2000 when the shortage was building. Foreign imagers took on a negligible portion of the workload. No reductions in retirement occurred among radiologists during 2000-2003, a 10-20% decrease in the annual number of residency graduates occurred, and no increase in residents going directly into the workforce rather than taking a fellowship was noted. Radiologists' average annual work hours were relatively constant, increasing by perhaps 2%. Work done per hour--that is, productivity--increased sharply (by approximately 15%) during this period.

CONCLUSION

Increased productivity is the predominant explanation of how the radiologist shortage eased. The contribution of other factors was, in comparison, small or even in the opposite direction.

Comparison of radiologists and technologists in the performance of air-contrast barium enemas

OBJECTIVE

The purpose of this study was to determine whether the rate of polyp detection and the quality of air-contrast barium enema (ACBE) procedures performed by technologists differ from those performed by radiologists.

CONCLUSION

Our results showed that well-trained certified technologists can perform ACBE similar in overall quality and accuracy to ACBE performed by attending physicians and residents. Training technologists to perform ACBE may help to alleviate the radiology staffing shortage in the United States.

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.

Trends and future needs in clinical radiology: insights from an academic medical center

OBJECTIVE

Advances in technology, expanding indications and defensive medical practice, in combination with population aging, have all contributed to a substantial increase in utilization of imaging and therapeutic radiology procedures in recent years. Moreover, the integration of education, innovation and research into high-volume workflow, although challenging, is a key requirement in teaching hospitals. Therefore, identifying forthcoming demand in the use of radiology services at a referral center might be of special interest and facilitate health policy planning in this context.

METHODS

Data regarding conventional radiographic, ultrasonographic and computed tomography (CT) investigations, radiotherapy sessions, and interventional procedures were collected for a 5-year period (2000-2004). Based on these observations, we deployed appropriate models to forecast utilization rates in 2005-2009.

RESULTS

Between 2000 and 2004, ultrasound examinations increased by 31.8%, mammography by 31.6%, CT scans by 17.4%, interventions by 14.5% and radiotherapy sessions by 13.9%, while conventional investigations decreased by 42.5%. We identified significant increasing trends for ultrasound, mammography, CT and interventions (all p<0.001 for linear component). Compared to current levels, the workload for these modalities is expected to rise in the next 5 years by 43%, 31%, 20% and 14%, respectively. Radiotherapy sessions demonstrate an unstable, non-significant increasing trend (p=0.189), while utilization of conventional radiography declines rapidly (p<0.001 for linear trend, 5-year prediction -51%).

CONCLUSIONS

In forthcoming years, the demand for radiology services at referral centers will increase substantially. Advances in digital technology alone will not suffice to completely alleviate the need for additional resources and well-trained personnel.

Cost accounting in radiology: new directions and importance for policy

OBJECTIVE

The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next.

CONCLUSION

The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.

The Diffusion of New Imaging Technologies: A Molecular Imaging Prospective

Molecular imaging is a complex of technologies that will diffuse into clinical practice over the next 10 to 20 years. Because of characteristics of both the technology and the environment, molecular imaging has the potential to be disruptive to conventional radiology practice. Environmental influences, including scientific and clinical characteristics of the technology, the interests of commercial firms, competition among radiologists and with other specialists, and regulation and reimbursement decision making will influence both the pace of diffusion and the eventual success of various molecular imaging technologies. Molecular imaging poses both threats and exciting opportunities for radiologists. Radiologists must decide how they wish to cope with the advent of molecular imaging, choosing for the present among ignoring its potential, attempting to fit molecular imaging into current practice models, or morphing how they practice to accommodate molecular imaging as a part of radiologic 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.

The Radiology Class of 2005: Postresidency Plans

PURPOSE

To examine the postresidency plans of the radiology residency class of 2005, including influences on and trends in the decision to pursue subspecialty fellowship training after residency.

METHODS

An electronic survey composed by the ACR Resident and Fellow Section was completed by 416 senior residents (a 46.9% response rate) enrolled in allopathic radiology residency programs from across the United States, representing approximately 41.2% of the entire residency class.

RESULTS

Eighty-seven percent (95% confidence interval 83.8% to 90.2%) of respondents plan to do fellowships immediately after residency, representing an increasing number, compared with published figures from the 1990s. Increasing age at the completion of residency was independently and significantly correlated with the decision not to pursue a fellowship. There has been a shift in the most popular fellowships, with an increased interest in musculoskeletal radiology fellowships and decreased interest in interventional radiology. Among residents not pursuing immediate fellowship training, the most common plans were private practice positions (48.1%), military obligations (22.2%), and nighthawk positions (9.3%).

CONCLUSION

An increasing number of residents are electing to pursue subspecialty training after the completion of residency. Close monitoring of the postresidency plans of current residents may portend important trends in education, residency training, and changes in the radiology workforce.

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.

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

PURPOSE

To use weighted data and information on hours worked to investigate further the market for radiology services by analyzing the extent to which radiologists wanted less or more work in 2003.

MATERIALS AND METHODS

Weighted data were used from the American College of Radiology's 2003 Survey of Radiologists. A statement on the survey cover sheet indicated that responses would not be individually identified, and responses were processed by an outside contractor for enhanced assurance of confidentiality. The authors analyzed workloads and the desired workload changes for radiologists who wanted less work, those who wanted more work, and those who sought no change in their workload. Multivariate regression analysis was also used to identify the probable causal links between characteristics of radiologists and the practices they work in and their desire for a workload change.

RESULTS

The net average workload change sought was approximately 0.1% of the current workload and was not significantly different from zero, indicating that the overall total workload is what is desired. However, radiologists working in academic or government practices sought 4% and 12% more work, respectively, while those in private practices sought 2% less. In addition, radiologists working in nonmetropolitan practices sought 3% less work than those in large metropolitan areas.

CONCLUSION

There was an overall balance between the demand and the supply of radiologists in 2003. The authors found some imbalances, including surpluses in academic and government-owned practices, a shortage of radiologists in private radiology groups, and a shortage in nonmetropolitan areas. There were differences in radiologists' desired workload by sex, age, and type and location of practice.

Emerging strategic themes for guiding change in academic radiology departments

Academic radiologists are faced with increasing demands on their time and energy, particularly in the clinical arena, where larger examination volumes and higher service expectations are the norm for most medical centers. These demands are intensified by the continuing shortage of academic radiologists. If academic radiology departments continue to devote most of their resources to the clinical mission at the expense of research and educational missions, then there are potentially serious adverse consequences for long-term viability of the profession of radiology. This dilemma represents a critical strategic problem, not just for academic radiology but also for the entire profession of radiology. In this article, the success and growth of academic radiology during the 20th century are framed as the result of the dogged pursuit of certain key strategic themes. With the concept of paradigm shift, introduced by Kuhn, several new strategic themes are identified that are just emerging from changes in work practices, organizational structure, and mind-sets in radiology departments at academic medical centers. One benefit of this approach is that it facilitates the ability of radiologists to articulate and focus on those strategic themes that will help academic radiology departments to adapt more rapidly and successfully to environmental changes during the 21st century.

Current realities of delivering mammography services in the community: do challenges with staffing and scheduling exist?

PURPOSE

To evaluate the current (2001-2002) capacity of community-based mammography facilities to deliver screening and diagnostic services in the United States.

MATERIALS AND METHODS

Institutional review board approvals and patient consent were obtained. A mailed survey was sent to 53 eligible mammography facilities in three states (Washington, New Hampshire, and Colorado). Survey questions assessed equipment and staffing availability, as well as appointment waiting times for screening and diagnostic mammography services. Criterion-related content and construct validity were obtained first by means of a national advisory committee of academic, scientific, and clinical colleagues in mammography that reviewed literature on existing surveys and second by pilot testing a series of draft surveys among community mammography facilities not inclusive of the study facilities. The final survey results were independently double entered into a relational database with programmed data checks. The data were sent encrypted by means of file transfer protocol to a central analytical center at Group Health Cooperative. A two-sided P value with alpha = .05 was considered to show statistical significance in all analyses.

RESULTS

Forty-five of 53 eligible mammography facilities (85%) returned the survey. Shortages of radiologists relative to the mammographic volume were found in 44% of mammography facilities overall, with shortages of radiologists higher in not-for-profit versus for-profit facilities (60% vs 28% reported). Shortages of Mammography Quality Standards Act-qualified technologists were reported by 20% of facilities, with 46% reporting some level of difficulty in maintaining qualified technologists. Waiting times for diagnostic mammography ranged from less than 1 week to 4 weeks, with 85% performed within 1 week. Waiting times for screening mammography ranged from less than 1 week to 8 weeks, with 59% performed between 1 week and 4 weeks. Waiting times for both diagnostic and screening services were two to three times higher in high-volume compared with low-volume facilities.

CONCLUSION

Survey results show shortages of radiologists and certified mammography technologists.

Professional and economic factors affecting access to mammography: A crisis today, or tomorrow?

BACKGROUND

Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S.

METHODS

Between October 2003 and April 2004, the SBI conducted a survey of the SBI membership database, and received completed surveys from 575 breast imaging practices in the U.S. Responses to the survey regarding practice characteristics, the utilization of standard and emerging technologies, staffing, malpractice, finance, and morale were analyzed.

RESULTS

Job vacancies for radiologists who read mammograms were reported in 163 practices (29%), 59 of which (10%) had 2 or more openings. A higher proportion of practices with job openings had long appointment waiting times for asymptomatic women when compared with fully staffed practices. Unfilled fellowship positions also were common, with 41 of 65 practices that offer fellowships reporting 47 openings. Among 554 responding practices, 55% reported that someone in their practice was sued because of a mammography related case within the past 5 years, and 50% of practices reported that the threat of lawsuits made radiologist staffing "moderately" or "a lot" more difficult. Of 521 responding practices, 35% reported financial losses in 2002. One in 5 respondents reported that they would prefer to spend less time in mammography, and fewer than 1 in 3 would recommend a breast imaging fellowship to a relative or friend. Emerging technologies, such as breast magnetic resonance imaging and screening ultrasound, currently are being performed in many practices.

CONCLUSIONS

The survey results provide support for anecdotal reports that breast imaging practices face significant challenges and stresses, including shortages of key personnel, a lack of trainees, malpractice concerns, financial constraints, increased workload due to emerging technologies, low appeal of breast imaging as a career specialty, and the steady rise in the population of women of screening age.

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.

Professional resource cost of body CT examinations: Analysis of interpretation costs in different patient populations

PURPOSE

To study professional cost and cost drivers in body computed tomography (CT), and to compare the professional cost associated with similar CT studies performed on patients with dissimilar diseases.

METHODS

A time and motion study was undertaken to measure the allocation of physician time in body CT. The hourly cost of radiologists' clinical practice was calculated. The physician cost associated with individual CT patients was then calculated according to the amount of time radiologists devoted to each patient. Technical costs and hospital overhead were not included.

RESULTS

The hourly cost of the clinical practice of attending radiologists, cross-sectional imaging fellows, and senior radiology residents was $293, $35, and $35 respectively. The average professional cost for CT examination of an abdominal pain patient with abdominal and pelvic imaging was $63. The average professional cost for CT examination of an oncology patient with abdominal and pelvic imaging was $90. The cost per relative value unit (RVU) was $25 for abdominal pain patients and $35 for oncology patients.

CONCLUSION

Similar CT studies performed on patients with dissimilar diseases result in differing professional costs.