As the US population ages, Medicare radiologists are bunching up in some areas and thinning out in others
There are plenty of radiologists serving Medicare patients in the U.S., but the headcounts are so unevenly distributed that patient populations in some vicinities can count on quick exam results while those in many other places get used to anxiously awaiting the doctor’s word.
Mayo Clinic radiology researchers confirmed the suspected state and regional disparities when they analyzed claims data in publicly available CMS databases alongside state-by-state Medicare enrollment figures as compiled by the Kaiser Family Foundation.
Aditya Khurana, MD, Bhavika Patel, MD, and Richard Sharpe Jr., MD, MBA, had their work published Aug. 10 in JACR [1].
Focusing on a seven-year period ending in 2019, the team tabulated changes in growth rates of radiologists per 100,000 Medicare enrollees and of Medicare enrollees themselves.
Khurana and colleagues found the overall number of radiologists per 100,000 Medicare enrollees grew—albeit slowly enough to signify stability—from 79.7 in 2012 to 79.9 in 2019.
Coverage Chasms Wide at the State Level: Minnesota Feast, Wyoming Famine
In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South and Midwest but higher than average in the Northeast and West, the authors report.
By 2019, only the South was lower than the national average—some 12% so, with 69.8 rads per 100,000 enrollees.
The ratios were up in every other region—1.9% over average in the Midwest (81.4 rads per 100K enrollees), +24% in the Northeast (99.3 per 100K) and +0.4% in the West (80.2 per 100K).
Meanwhile, at the state level, the gaps were vast in 2019. For example, Minnesota had 161.4 radiologists for every 100,000 Medicare enrollees (102% over national average) while Wyoming had only 38.8 (-51.5%).
The most radiologist-saturated area was Washington, D.C., with 200.5 rads per 100,000 Medicare patients. That was 151% over the national average.
Rounding out the top three in 2019 was Connecticut (50.9% above national average).
Keeping Wyoming company at the bottom were Mississippi (-50.8%) and South Carolina (-42.3%).
The disparities are increasingly concerning, the authors suggest, as the U.S. population continues to both age and grow. They write:
Over the past decade, the over-65-years population cohort has grown by 34% (+15 million), more rapidly than any other age cohort. As the population in the United States ages, efficiently providing high-quality imaging services to our aging population will increasingly require alignment of the rate of growth of radiologists and Medicare enrollees both nationally as well as by region and state.”
Of a Piece with the Gathering Physician Shortage: ‘Potential Concern for Local Allocation of Imaging-based Healthcare Resources’
Among findings Khurana and colleagues highlight for special consideration:
- From 2012 to 2019, growth in the national supply of radiologists (+5.5%) was commensurate with growth of Medicare enrollees (+5.1%)— “suggesting, at least nationwide, comparable growth of the Medicare population and practicing radiologists,” they comment.
- By region, the West experienced growth of the Medicare population (+17.0%) that outpaced growth of diagnostic radiologists submitting claims to Medicare (+5.7%) by 11.3%, “raising question of decreased imaging access for Medicare enrollees in this region.”
- By state, there was a 4.2-fold variation in the number of radiologists per 100,000 Medicare enrollees, “raising potential concern for the local allocation of imaging-based healthcare resources.”
Citing previous research predicting a significant overall physician shortage by 2030 [2], the West being particularly vulnerable, Khurana and colleagues note this forecast’s alignment with their finding that 34 of 51 states (66.7%) had below the national average number of radiologists per Medicare enrollees as of 2019.
Optimize Radiologist Productivity Now, Map Alternate Routes for Later
The researchers offer some ideas for targeted strategies to head off the looming paucity of radiologists in areas with low and falling local access.
Such strategies “could include increasing the local pipeline of radiologist training opportunities, attracting additional radiologists to the region with incentives or other efforts to reduce barriers to entry, or increasing the productivity of existing radiologists,” Khurana et al. write.
Until those kinds of measures gain traction and make a difference, approaches to boost radiologist productivity while maintaining high quality of care might include hiring midlevel providers, leveraging reading-room assistants and/or investing in AI, the authors point out.
The team concludes:
The growth of Medicare-serving radiologists and Medicare enrollees was stable nationally [between 2012 and 2019] and demonstrated tremendous variations by U.S. region and state. These variations bring to light potential implications for patient access to care and distribution of healthcare resources.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.