Radiology sees ‘substantially lower' relative growth in training capacity compared to rest of medicine

Radiology has experienced “substantially” lower relative growth in training capacity compared to rest of medicine, according to new research published Wednesday. 

Medicare Graduate Medical Education funding is the primary way in which the federal government supports physician training. In 2023 alone, the payment program for seniors contributed over $21 billion to GME, covering resident salaries, program infrastructure and other expenses, experts write in JACR. 

However, the number of Medicare-funded residency positions has remained capped since the Balance Budget Act of 1997, limiting the number of new positions teaching hospitals can add. 

“Although total Medicare GME spending has grown substantially in nominal terms since that cap was established, it remains unclear whether this growth reflects a genuine increase in per-resident federal investment or is primarily a function of volume expansion across an increasingly large trainee workforce,” corresponding author Ajay Malhotra, MD, a radiology researcher with Yale’s School of Medicine, and colleagues wrote July 22. “For radiology, this distinction matters. Imaging utilization has grown substantially over the past decade, while attrition among practicing radiologists has accelerated, with unadjusted rates increasing from 1.1% in 2014 to 2.5% in 2022,” they added, citing another recent study.

Malhotra et al. sought to determine whether the GME system has directed the appropriate portion of resources toward radiology, or if the profession has fallen behind other specialties. They utilized data from the National Resident Matching Program spanning 2010 to 2023, comparing radiology against family medicine. The authors also analyzed data from the Robert Graham Center, a primary care policy research organization affiliated with American Academy of Family Physicians. Malhotra and colleagues selected family medicine as a comparison point because it represents the largest primary care specialty by position count and has been a priority for federal GME funding. 

Between 2010 and 2023, radiology resident positions increased by about 24%, up to 1,354. In comparison, total residency positions across all specialties increased by about 58% while family medicine positions jumped by 95%. 

“Radiology, thus, experienced substantially lower relative growth in training capacity than both the overall residency landscape and family medicine,” the authors noted. 

Total GME payments increased approximately 115% between 2010 to 2023, up to $21.7 billion. After adjusting to 2023 dollars, however, real GME payments only rose about 54% over that 13-year period. During the same time, total resident full-time equivalent positions increased about 32%, up to 252,086, “accounting for a substantial portion of aggregate GME growth.” 

When examined on a per-resident basis, the funding picture is “considerably more constrained.” Nominal per-resident GME funding increased about 62% during the study period, up to $85,902. But when adjusting for inflation, the net increase was only about 16%, representing about 1.2% annual growth. Whether this pattern has constrained radiology training capacity could not be determined without specialty-specific GME data, which is not currently available, the authors wrote. 

They highlighted recent survey data, showing that about 85% of radiology program directors in the U.S. have capacity to expand positions. Money was pinpointed as the primary limiting factor preventing expansion. 

“These findings collectively suggest that the bottleneck in radiology training capacity may be financial rather than structural, and that development of specialty-level GME reporting infrastructure is a necessary precondition for designing targeted federal funding interventions,” the authors concluded. “Relevant legislative efforts [are] underway, including the Resident Physician Shortage Reduction Act and MedPAC recommendations for targeted GME allocation represent important opportunities to incorporate specialty-specific workforce data into federal funding policy.” 

Read more, including potential study limitations, in the Journal of the American College of Radiology.