Subspecialized radiologists exiting workforce at higher rate than generalist colleagues
Subspecialized radiologists appear to be exiting the workforce at a higher rate than their generalist colleagues, according to new research from the Neiman Health Policy Institute.
Attrition rates also are higher for female and nonacademic rads when compared to counterparts who are male or operating in teaching settings. The findings were derived from an analysis of healthcare claims data spanning commercial, Medicaid, Medicare, and Advantage plans, published Wednesday in the American Journal of Roentgenology.
“It is important for practice leaders to recognize … that attrition differs between subspecialists and generalists and by academic status so that they can identify local solutions to minimize attrition,” study co-author Jay Parikh, MD, a radiologist and professor with the MD Anderson Cancer Center, Houston, said in an Oct. 1 statement from the policy institute. “Further, the present radiologist shortage may be exacerbated by trends towards increased subspecialization and practice consolidation in radiology, which our study shows have secondary effects in the form of higher attrition.”
For the study, researchers utilized claims data spanning 2014–2022 to identify radiologists no longer clinically active after a given year. They further used Centers for Medicare & Medicaid Services information to help determine radiologist characteristics such as specialization, gender, years of practice, and workplace setting. Altogether, the analysis included 41,432 rads spanning over 298,000 total practice-years of observation.
Radiologist attrition rates rose from about 1.1% in 2014 up to 2.5% by the end of the study period (figures that are unadjusted for various mitigating factors). Subspecialized radiologists were about 37% likelier to leave the workforce than their generalist colleagues during this time span, the analysis found. Same for nonacademic rads, who faced 34% higher odds of attrition versus those practicing in teaching settings. Odds of leaving the workforce also were higher for female radiologists (26%), those in the Midwest (19%) compared to the Northeast, and among rads operating at 1 or more rural sites (16%).
Conversely, odds of attrition were lower for those in multispecialty groups, whether the practice was majority radiologist (19% lower odds) or other physician specialties (22% lower). Attrition rates rose both among subspecialized rads during the study period (from 1.4% in 2014 up to 2.7% by 2022) and generalists (0.9% to 2.2%). Trends also were similar between academic (1% to 2%) and other rads in nonteaching settings (1.1% to 2.7%).
In the study’s discussion session, Parikh and colleagues noted that the specialty has been challenged by increasing imaging volumes, growing expectations outside of regular clinical work and the loss of autonomy. Combined, these factors drive burnout and likely are pushing up attrition rates, with the COVID-19 pandemic also a key factor.
The authors did not attempt to ascertain why subspecialists are leaving the workforce at a higher rate, but they offered some guesses.
“On one hand, an increased ability to practice in one’s chosen area should lead to increased job satisfaction of subspecialists,” the authors wrote. “On the other hand, depending on the practice, subspecialists’ narrower focus may lead to increased stress from higher case complexity, additional after-hours call responsibilities related to their subspecialty, or increased volumes due to exclusive responsibility for handling certain examination types across their practice. Indeed, high prevalences of burnout have been demonstrated for several distinct radiology subspecialties.”
Meanwhile, academic radiologists typically face additional pressures than their private practice counterparts, including teaching, research and other bureaucratic requirements. Despite this, radiologists outside academia appeared to leave the workforce at a higher clip. Experts highlighted previous studies showing greater prevalence of burnout in private practice, potentially explaining this disparity. Also, higher compensation in nonteaching settings may enable such docs to leave the workforce earlier, the authors added.
Neiman Health Policy Institute experts also speculated why attrition rates are higher for those working in rural settings.
“Remote practice locations present unique workplace challenges, including potentially reduced opportunities for meaningful interactions with colleagues; such separation can drive isolation, dissatisfaction and burnout,” the authors noted. “Over the last decade, academic radiology practices have been strategically expanding into their broader geographic regions, helping to improve access to subspecialty radiology services for underserved populations. As pursuing these expansions, academic practices should implement solutions to ensure that radiologists working from new remote sites remain engaged with the rest of the department, to minimize potential adverse effects on attrition.”
Researchers urged radiology leaders to use these results in evaluating issues related to retention in their own practices. For instance, managers could compare their historical turnover rates to such stats to help guide and focus workforce management and retention activities.
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.