Radiology workforce shortage a major concern for the American College of Radiology

The magnitude of the radiology staffing shortage

At RSNA 2023, concern about the shortage of radiologists and technologists was palpable. Most of the conversations Radiology Business had with vendors and radiologists frequently circled back to the workforce issue, highlighting its prevalence. The recruitment area at the expo, typically a quieter zone, was unusually busy with a large number of both health systems recruiters and attendees browsing to see what they had to offer. It reflected the high demand for radiology professionals and the increasing interest from job seekers to see what incentives and pay bumps are being offered in this challenging market.

Nearly all vendors Radiology Business spoke with across the expo at RSNA said the doctors and health system customers they are meeting with identify the staffing shortage as their biggest concern and are asking for technologies they can leverage to save staff time. Radiologists we interveiwed said the number of residency slots needs to be increased quickly. Some said easing immigration laws and certification requirements for foreign radiologists who want to come to the U.S. could help as well.

Causes of the radiologist shortage

"We've had workforce shortages in the past, but they tended to be shorter term. This one I think is going to be more enduring. There are several forces at play here," she said. Smetherman outlined these in detail:

Aging population: As the population ages, the demand for imaging studies increases. Older individuals typically require more frequent imaging for various health conditions, from cancer to vascular diseases, leading to a higher volume of studies.

Success in medical advances: Advances in medical treatment have led to longer survival rates for many conditions, necessitating ongoing follow-up imaging. While this is a positive outcome, she said it also means a sustained and growing demand for imaging services is the result of the success of medicine in prolonging lives. 

Increased insurance coverage: The Affordable Care Act has significantly reduced the number of uninsured individuals in the United States, increasing demand for healthcare services, including radiology. However, she said this expansion in patient access was not matched by a corresponding increase in the healthcare workforce, exacerbating the shortage.

Steady supply of radiologists: Despite the rising demand, the number of radiology residents entering the field has remained relatively flat. While there has been a slight increase in residency positions, it is not enough to keep pace with the growing need for imaging studies, especially advanced imaging like CT and MRI, which are increasing by 3% to 5% annually.

"We just are going to need more people to take care of the patients," Smetherman explained.

Possible solutions to the healthcare staffing shortage

To address the radiology workforce shortage, Smetherman emphasized the need for a multifaceted approach:

Expanding radiology residencies: Smetherman said ACR advocates for expanding residency programs as the most effective long-term solution. Increasing the number of radiologists entering the workforce is essential to meet the growing demand for imaging services. 

Improving efficiency: In the short term, improving the efficiency of existing radiologists through better workflows and technology may help mitigate some of the strain. However, Smetherman acknowledged that this alone will not be sufficient to address the magnitude of the problem.

Appropriate use of imaging: The ACR continues to advocate for policies like the Protecting Access to Medicare Act legislation, which called for requiring proof of appropriate use criteria software being consulted to show an imaging study requested falls under the guidelines for what is being tested. Medicare dropped the AUC requirement in 2024 and there are efforts by some medical groups to have the part of the law completely repealed because of the administrative burden and increases in IT costs. However, Smetherman said reducing unnecessary imaging tests would go a long way to helping reduce the number of exams to lighten the radiology workload. She said the college is now supporting efforts to use AUC to replace prior authorization, which are also causing massive administrative burden and leading to radiologist burnout. 

The role of AI in radiology to offset the staffing shortage

Artificial intelligence is often touted as a potential solution to the radiology workforce shortage, but Smetherman remains cautious about its current capabilities. While AI can assist with tasks like lesion measurement, helping identify hard to see or rare abnormalities, and aid in report creation and back-end workflow, it does not necessarily reduce the overall workload for radiologists. Instead, she said AI might even increase the workload by identifying additional findings that require further examination.

"Certainly on the generative AI side where you might have assistance with formulating your reports, and AI triage tools that might bring the most critical studies up to the top of the reading list, I think that helps you manage the workflow," Smetherman explained.

But in terms of AI reducing workloads, "I don't think we are there yet," she said.

Smetherman pointed out that AI has tremendous potential to improve patient care, especially through opportunistic screening to find disease much earlier when it is more easily treated. However, while better for patients, she added AI acting as a second set of eyes on exams will likely add a lot more work for radiologists who will need to then review and confirm all the incidental findings. That also may be a negative impact in increasing workloads and leading to more burnout.