Navigating the radiology workforce shortage: 6 potential solutions
A panel of imaging experts are suggesting six potential solutions to address the specialty’s workforce shortage.
Radiologist Anna Rozenshtein, MD, and colleagues conducted a literature review for their new opinion piece, published Wednesday in the American Journal of Roentgenology. They highlighted some of the history leading up to this predicament, including rising imaging volumes, previous concerns about radiologist oversupply, and burnout.
“The unsustainable dynamics of radiology practice warrant an intense look at the economic implications of the interplay between workforce availability, radiology utilization, and lifestyle expectations,” Rozenshtein, an associate professor of radiology at New York Medical College in Valhalla, N.Y., and co-authors wrote Dec. 18. “Without major structural adjustments, current practice patterns and downward pressures on healthcare costs may lead to abandonment of radiologist expertise and further movement towards imaging interpretation as a low-value commodity rendered without radiologist input.”
A review of the American College of Radiology job board reveals a rapid increase in posted positions, leaping from 611 in 2010 up to over 14,000 in 2022. As of Aug. 8, there were over 1,900 positions listed, a number that likely undercounts the overall total, the authors noted. Meanwhile, utilization of CT, MRI and ultrasound is expected to continue climbing due to the rising prevalence of cancer and heart disease. An aging population and need to better tailor therapies via imaging will likely further exacerbate these numbers.
Based on their literature review, Rozenshtein and co-authors offered six possible actions to address the shortage:
1. Promoting the appropriate use of imaging: Unnecessary imaging makes up about 20% to 50% of radiology exams, according to previous research. Tools such as clinical decision support and appropriate use criteria could help to address these numbers, reduce volumes and bolster capacity. Value-based care initiatives also may fuel this push and shift radiologists away from the fee-for-service mindset and desire to chase more RVUs for greater compensation.
2. Leveraging existing workforce reserves: In private practice, radiologists have seen their vacation time increase to an average of 45 days versus 25 in academia. This, the authors noted, may constitute a “workforce reserve.” In times when revenues are high, practices may consider increasing staffing and offering more time off. Conversely, amid economic downturns, income preservation prevails and vacation time shortens, “enabling practices to avoid hiring new staff.”
3. Strengthen the delivery of high-quality education: Remote work in radiology fits the lifestyle expectations of younger rads, the authors noted. However, this can strain the apprenticeship model and may further disrupt the dynamic between volume and compensation when these residents eventually enter clinical practice. Remote instruction may be one way to help, though one study found that resident productivity decreases when they’re supervised by an off-site physician. A hybrid model of both remote and in-person instruction may benefit faculty well-being and recruitment, they added.
4. Embracing innovation: Electronic educational platforms such as RadPrimer and STATdx help residents increase their imaging know-how. Some educators are even using artificial intelligence to customize teaching and assign cases based on each individual’s level of training.
“One described strategy for maintaining a successful hybrid academic environment entailed ensuring that a critical mass of academic radiologists remained on-site, compensating such radiologists for activities that do not generate RVUs but that cannot be performed from home (e.g., in-person consultations, face-to-face patient encounters, and hands-on teaching),” Rozenshtein et al. wrote, pointing to the web-based Adaptive Radiology Interpretation and Education System as one example of such innovation. “This system integrates imaging and clinical findings to help residents formulate a differential diagnosis. While it is too early to tell whether AI-powered intelligent tutoring systems can offset the negative effects of understaffing and remote instruction, their adoption is increasing.”
5. Bolstering radiologist workforce capacity: Minor interventional procedures that are in high demand are increasingly being shifted to nurse practitioners or physician assistants, the authors noted. One study showed that the volume of IR procedures performed by NPs grew 143% between 2010 and 2021.
“This practice expands capacity when physicians are in short supply,” the authors noted.
Increases in ED imaging force radiology practices to accommodate rising off-hour demand by upping overnight staffing. But because off-hours coverage requires greater compensatory time off, this reduces efficiency per full-time equivalent rad, “lowering practice workforce capacity.” Radiology could consider help support efforts to ensure that patients receive care (where appropriate) in other settings during regular hours, offsetting ED demand and further boosting capacity."
Practices could consider creating conditions to help better retain older radiologists, while training programs might recruit international radiologists in the ABR Alternate Pathway, they added.
6: Facilitate the adoption of AI tools and other emerging tech: The U.S. Food and Drug Administration has cleared nearly 1,000 AI-enabled devices and algorithms, with most being in radiology. Adopting this technology as an independent assistant is unlikely in the near-term, “given the unresolved questions of medical liability and errors.”
Radiologists should seek to investigate these tools’ risk and benefit, focusing on how they improve outcomes, enhance education and increase productivity.
“However, the severity of the current mismatch between clinical needs and the size of the radiologist workforce ensures that our profession will continue adopting technology when it is proven to increase productivity and maintain diagnostic accuracy, thus reducing radiologist workload and alleviating burnout,” the authors noted.
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.