Pediatric radiology continues to face ‘major’ workforce shortage

Pediatric radiology continues to face sizable staffing shortages, according to new research published Tuesday. 

For years, the subspecialty has grappled with decreasing trainee interest and a competitive market for talent. Researchers aimed to gauge the current state of these trends, surveying nearly 2,000 rank-and-file radiologists and imaging decision-makers. 

They published their findings this week in the Journal of the American College of Radiology. 

“The pediatric radiology subspecialty continues to experience a major workforce shortage resulting from a combination of decreased trainee interest in pediatric radiology fellowships, increased clinical volumes, increased staffing demands, and a competitive job market…,” lead author Shannon G. Farmakis MD, chief of pediatric imaging at Mercy Children’s Hospital in St. Louis, and colleagues wrote March 11. 

Researchers administered the survey in early 2024, targeting members of the ACR and Radiology Business Management Association. (The two trade groups released the preliminary results in September but did not discuss the findings pertaining to pediatrics.) They received 1,927 responses including over 535 decision-makers, 1,107 rank-and-file radiologists, 285 retired rads, and 350-plus partners/owners of radiology practices. About 42% of respondents worked in a private practice at the time of the survey, 32% in academics, 15% in hospitals, and 11% in teleradiology/locums/the VA/other settings. 

Around 11% of imaging decision-makers listed pediatric radiology as a top 3 hiring need in the latest survey. That’s up from 10% in 2022 and 9% in 2021. While these numbers may seem low, the authors noted, they’re still triple the 3% to 4% footprint that pediatric radiology traditionally has held in the profession. About 66% of decision-makers who identified as pediatric radiologists said that the specialty was a top 3 hiring need in their organization. At the time of the survey, 10% of pediatric radiologists were likely to retire by the end of 2024 versus 8% across all respondents. Only nuclear medicine and women’s imaging had higher tallies—both at 11%. 

Among rank-and-file rads, 74% said they are understaffed in pediatric radiology, and 64% of decision-makers said the same. That’s compared to 68% of radiologists feeling understaffed and 71% of decision-makers across the entire survey sample. Meanwhile, 21% of radiologists (and 32% of decision-makers) said their organization is fully staffed in pediatric imaging, 2% overstaffed, and 3% “unsure.” “Five additional radiologists” was the most common answer when asked how many more physicians were needed. 

“Although the differences are not statistically significant, the results are directional and imply that there is a perception discrepancy between decision-makers and rank-and-file respondents with regards to staffing,” the authors noted. “While the decision-makers may have less clinical time because of administrative duties, they are also typically more cognizant of the practice’s volumes and staffing needs whereas the rank-and-file respondents are likely more in tune with day-to-day staffing.”

Pediatric radiologists were more likely to be allowed to work from home than others in the specialty. Around 96% of rank-and-file rads reported teleworking during the day and 90% do so at night, with 0% unable to work remotely. That’s up from about 81% of pediatric rads who said they could telework in 2021, the authors noted. The next closest subspecialties were neuroradiology, with 90% of respondents allowed to telework during the day, and 82% in women’s imaging able to do so on night shifts. All other subspecialties had at least some percentage who said they could not work from home. 

“The fact that more employers now allow for higher percentages of remote reading in pediatric radiology can be construed as a multipronged effort to keep existing staff working, an attempt to make a job more appealing to new hires, and ensuring adequate staffing to cover increasing exam volumes,” Farmakis et al. wrote. “However, in practice, this methodology tends to place a disproportionately greater work ‘burden’ on those pediatric radiologists that spend more of their time in the hospital setting in order to cover fluoroscopy cases through increased travel time to/from the hospital and potential decreased productivity given the time requirement for performing fluoroscopic exams and time away from the workstation. This may have the unintended consequence of contributing to burnout leading to an increased desire to leave for 100% remote jobs.”

Use of nonphysician providers is higher in pediatrics, possibly because of these staffing challenges. About 54% of decision-makers reported using nurse practitioners, 54% physician assistants, and 23% radiology assistants. Nuclear medicine was the only subspecialty with a higher rate of NPP employment, including 70% reporting the utilization of NPs, 74% PAs, and 44% RAs. For unclear reasons, the percentage of respondents using NPPs in pediatrics decreased from the 2021 tally of 91% who said they used nonphysicians, the authors noted. 

About 47% of rank-and-file pediatric radiologists said their work-life balance is skewed more toward the work side. Another 41% said the balance is even, and 11% believe the scale is tipped toward their personal life. Experts also highlighted low AI adoption in pediatrics, with 5% deploying the technology for prior authorization and 8% for patient scheduling.

“This reinforces…that use of AI in pediatric radiology is limited by the fact that very few products have FDA approval for use in pediatric radiology,” the authors noted. 

Pediatric radiology decision-makers reported earning an average annual income of $532,868. About 69% said they earn between $400,000 to $599,000 per year, and 13% said between $600,000–$699,000. Rank-and-file pediatric rads earned an average of $457,078. This included 57% making $400,000–$599,000 per year, 8% $600,000–$699,000, and 3% over $700,000 annually. Decision-makers likely earned more, the authors noted, given they have additional administrative duties or may hold a higher rank in the department. The figure is higher than the overall average salary for radiologists at $443,000, the survey found. 

When combining all pediatric respondents, the average income was about $495,000 versus $499,000 across all radiology subspecialties. When removing interventional specialties, the combined average was about $500,000, indicating there is no statistically significant difference in annual earnings for pediatric rads versus peers in other parts of the specialty.