‘Understaffing is ubiquitous’ in radiology, according to new ACR/RBMA workforce survey

“Understaffing is ubiquitous” in the specialty, according to the results of a new workforce survey from the Radiology Business Management Association and American College of Radiology, released Tuesday. 

About 69% of radiologists surveyed in 2023 believe their organization is understaffed, up from 67% the previous year. Only 23% of those polled feel their organization is fully manned, a drop from 25% in 2022. 

Respondents were more likely to consider their workplace shorthanded when working in practices wholly owned by a hospital or health system (75%). Same for radiologists that manage, teach or supervise residents (75%). 

“Radiology faces a volume of imaging that it has never experienced before and the retirement of baby boomers is going to have a compound impact on that, at once inflating the total patient count for radiologists and pulling much needed labor away from the radiology workforce,” Dominick Parris, senior environmental intelligence analyst for the ACR, told attendees during a webinar to reveal the results on Sept. 10. “There’s a problem.” 

While industry experts have expressed concern that radiologist retirements could compound workforce challenges, the ACR/RBMA survey gives some hope. About 86% of radiologists surveyed said they are “not very” or “not at all likely” to retire in the near term. This number represents an increase from 83% who said they’re likely to retire in 2022 and 78% the previous year. Conversely, the number of radiologists contemplating calling it quits has dropped in recent years. About 10% of physicians polled said they were “extremely” or “very likely” to retire in 2021. This number fell to 6% in 2022 and stayed steady at 6% last year. Same for those “moderately” likely to retire soon, dropping from 12% in 2021 to 8% last year. Parris noted that this likely reflects “waning pandemic effects” on retirement rates. 

Earlier this year, former ACR President Howard B. Fleishon, MD, suggested that the field could entice radiologists out of retirement to fill workforce gaps, and it appears there’s some openness to this. About 12% of retired radiologists said they’d consider returning to the workplace on a part-time basis, up from 4% in 2022 and 3% the previous year. Only about 4% said they’d do so on a full-time basis compared to 1% the previous two years. Meanwhile, 63% of radiologists said they would reduce their hours leading up to retirement, the same number as in 2022. Another 30% said they would not cut back on work prior to retiring, down from 35% in 2022. 

Between 1,600 and 3,000 radiologists could reach retirement age in 2024, the ACR estimates. However, broader trends show that despite the graying of America, about 24% of men and 15% of women 65 and older are remaining in the workforce, Parris noted.

“So, it is possible that retirees could help plug workforce gaps,” he said. 

A few more findings of note from the survey: 

• The proportion of respondents who indicate their practice allows telework of any kind has grown substantially. About 79% of respondents said they’re able to work from home during the daytime, up from 74% in 2022. Another 70% said they can telework on night shifts, up from 60% the previous year. And only 12% said their workplace does not offer remote shifts, down from 19% in 2022. “Telework is growing significantly,” Parris said. “I hate to disappoint my back-to-the-office folks, but the pandemic has changed a lot of things.” 
• About 39% of those surveyed said their practice is using physician assistants, up from 37% in 2022 and 32% in 2021. Another 28% said they utilize nurse practitioners, up from 27% the previous year and 22% in 2021. 
• Nearly half (49%) of respondents said they use some form of AI, up from 42% in 2022. This included about 16% who said they use both clinical and other forms of artificial intelligence, up from 11% the previous year. There was a marked leap in the number of respondents using AI to improve clinical productivity, rising from 41% in 2022 to 58% in 2023. 
• Most radiologists work under one of two ownership arrangements. About 34% said they are part of a practice wholly owned by a hospital or health system. The same number (34%) work for one owned by physicians. Meanwhile, 10% said they work for a practice jointly or wholly owned by investors, 9% jointly owned by physicians/hospitals, and 8% by a government entity. 

Parris also noted that the number of radiologists has remained relatively stable over the last five years. There were roughly 28,000 as of 2019 and 27,000 this year, according to AAMC data. Using compound annual growth rates, the number would hit about 27,000 in 2030. According to American Board of Medical Specialties data, these numbers would be about 46,000 radiologists in 2019, 50,000 this year and almost 56,000 by 2030. 

However, the U.S. population is aging more rapidly than the workforce can keep up with, driving imaging volumes upward. About 14% of the U.S. population was on Medicare as of 2013, growing to 16% this year. Using the CAGR formula, this number could hit 20% by 2030.

“Our manpower has been stable for the last 15 years,” RBMA Co-executive Director Linda Wilgus, MBA, said in an interview after the webinar. “Even if we would open up seats today, with the timeframe that it takes to mint new radiologists, we will be at the crescendo of the volume problem and likely on the downside. So, we’ve got to solve a problem today with other tools, remedies and solutions and not just keep throwing bodies at it. Because that won’t fix the problem. It just takes too long to get them through the pipeline. I’ve always thought of it as a manpower issue, but it’s a volume issue. We’ve got to try and figure out how to solve this.” 

The survey was conducted in the fall of 2023, receiving roughly 1,700 responses from individuals in the two associations' member databases. Respondents included over 400 decision-makers, 1,000 rank-and-file radiologists and 300 retired ACR members, altogether representing nearly 400 practices. ACR paused the survey in 2020 amid the pandemic and brought in back in 2021 with new questions. The association will eventually publish the findings in the Journal of the American College of Radiology.