Harvard economist claims imaging volumes are falling, blunting need for more radiologists
A Harvard University economist claims that imaging volumes are falling in the U.S., blunting the need for more radiologists.
David M. Cutler, PhD, a noted researcher and professor, shared the thought in an editorial published Thursday by JAMA Health Forum. He cited research including a 2019 study published by the Radiological Society of North America showing that imaging use stabilized or declined between 2010 and 2016.
Dipping utilization combined with lower reimbursement per procedure has led to a “sustained slowdown in imaging spending growth,” Cutler wrote.
“In addition to helping with cost concerns, the reduction in imaging use has helped to minimize a potential shortage of radiologists,” he wrote April 2. “For some time, economists were worried about a looming radiologist shortage. The decrease in imaging has allowed the U.S. to meet the need for imaging without an increase in radiologists.”
The claims appear to contradict both anecdotal and numerous published academic reports stating the contrary. Another RSNA-published study last year found that emergency departments’ use of CT imaging has increased substantially since 2013. Another JACR study published in January estimated that radiology exam caseloads climbed 31% since 2018. A third shared by Health Affairs in 2024 said overall spending on radiology services leapt almost 36% between 2010 and 2021.
Cutler and co-author Lev Klarnet, a doctoral student at Harvard, cited several potential reasons for the alleged “imaging slowdown.” These could include physicians realizing the potential harms of unnecessary scans, the Choosing Wisely campaign and reimbursement changes. Prior authorization, accountable care organizations and efforts to halt unnecessary repeat exams also could be possibilities, they wrote.
“There is no consensus on which of these hypotheses explain imaging trends, or whether there are other important factors. More attention to this would be valuable, given the need to continue to make healthcare affordable,” wrote Cutler, who was part of a Health Policy Commission created to help reduce medical spending in Massachusetts.
Cutler went on to cite artificial intelligence as one way “radiology can guide a path to the future.” Analyzing medical images is a “straightforward process for machine learning,” he added, with computer programs already able to “emulate radiologists” in some cases.
“It is unlikely that computers will replace radiologists any time soon. There are many situations where human ability outperforms AI, and that seems likely to continue for some time,” Cutler and Klarnet wrote. “In areas where radiologists are scarce (as in many rural areas), perhaps a computerized diagnosis is a reasonable substitute for a trained radiologist,” the authors added. “Or perhaps a triage system can be established where radiologists read the most difficult images (regardless of where the patient is located), and AI programs handle the routine cases. Medicine can and should plan for a future with greater ability to harness the power of AI, and imaging is a central place to start.”
Read the rest in JAMA Health Forum here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.