Twenty-nine radiology societies met recently to discuss some of the specialty’s most pressing problems, sharing several key takeaways Wednesday in JACR.
The group included representatives from all subspecialties of radiology, radiation oncology, academia and private practice. Meeting in Park City, Utah, last August, the discussions centered around the theme of “Recovering from the Great Resignation, Moral Injury and Other Stressors: Rebuilding Radiology for a Robust Future.”
Among all topics, one bubbled to the surface as requiring urgent attention, Bettina Siewert, MD, a professor of radiology at Harvard Medical School, and co-authors shared April 12.
“Of these, the mismatch between the clinical workload and the available radiologist workforce was foremost—as many other identifiable problems flowed downstream from this, including high job turnover, lack of time for teaching and research, radiologist burnout, and moral injury,” Siewert et al. reported.
The American College of Radiology Intersociety Committee offered up eight action items following their three-day meeting. While aspirational, the editorialists believe they’re achievable.
Here they are in brief:
1) Establishing a robust and sustainable workforce pipeline and retaining existing radiology professionals: Possible solutions could include having training programs partner with affiliated hospitals and private groups, gathering funds to support additional trainees, and developing new residency programs. Radiology also must increase medical students’ exposure to the specialty, the committee contended, while working to retain experienced radiologists.
“There is continued growth in imaging utilization, an uptick in retirement of radiologists, and a pipeline insufficient to meet the growth,” Siewert and co-authors wrote, later adding: “Hence, there is great need to establish a sustainable model that attracts and retains the most promising and talented medical students into radiology.”
2) Implementing appropriateness criteria to reduce waste: Low-yield radiology services are a key example of this, adding to the cost burden for patients while straining the imaging workforce. Medicine must consider programs that give credit for “saying no” to unnecessary care, along with greater implementation of efforts to better manage utilization.
“Many radiology professionals find themselves in a vicious cycle of productivity stress, professional frustration, work-life imbalance and burnout,” the authors wrote. “Reducing unnecessary work through utilization management will help to mitigate workforce shortages and improve professional perception of work value,” they added later. “However, ultimately appropriate utilization of imaging will only be adopted if incentives are aligned and when the current U.S. reimbursement model of fee-for-service is converted to one based on value.”
3) Positioning radiology as a consult specialty: Moving to such a model would require radiologists to provide comprehensive, patient-centered imaging. “Radiology orders” would instead become consultations, similar to how services from other specialists are classified. However, this would require a change in CMS rules to categorize radiologists as treating physicians.
“This paradigm shift would leverage the training and expertise of radiologists so that patients would receive appropriate services, such as the appropriate use of intravenous contrast, which should be at the discretion of the radiologist. Presently, the breast radiologist serves as a great model for how radiologists may function as consultants.”
4) Increasing the visibility of radiology: Along with establishing consultation services, radiologists also could expand their role in multidisciplinary conferences, strive to meet more patients, serve on hospital and society committees, and accept leadership roles.
“Radiologists must take every opportunity to improve their visibility,” the authors advised. “Our specialty should emphasize that radiology ‘touches’ every medical specialty—and nearly every patient—and we risk making ourselves and our profession vulnerable to commoditization if we purely focus on productivity.”
5) Improving communication with referrers and patients: The advent of patient portals presents an opportunity for members of the specialty to interact directly with healthcare consumers. Radiologists should capitalize by placing their photos in reports, sharing their contact information, writing in easily understood language, seeking feedback, offering interpreters, and even shooting short videos to explain findings.
“The radiologist’s report has become a dynamic work product over the last decade and continues to undergo transformation,” Siewert and co-authors wrote. “Due to the enactment of the 21st Century Cures Act in 2016, patients and referring providers now have simultaneous immediate access to finalized radiology reports via electronic patient portals, which has created a direct communication link between radiologists and patients. This provides us the opportunity to showcase our contributions directly to patients.”
6) Developing the hybrid workforce: The COVID-19 pandemic has helped increase the use of both on-site and remote radiologists. This shift has brought numerous positives, including helping ease the difficulty of raising children while practicing medicine. However, given the specialty’s aspirations mentioned earlier on this list, radiology leaders must strike a balance between both work models.
“The data indicate that neither fully on-site nor fully remote work are ideal; the combination that the hybrid workforce allows offers the optimal balance of service to our patients, value to our referring colleagues, and radiologist wellness. The push for fully remote work must be treaded carefully, as the lack of presence of the radiologist has contributed to many of the issues that the specialty is currently facing.”
7) Improving staff well-being and facilitating mentorship/sponsorship: The specialty’s burnout problem is well-documented, and there are numerous solutions to address it. Siewert and co-authors listed some of the options, which could include offering part-time or remote positions, listening to team members to identify early warning signs of distress, and utilizing AI to relieve administrative burdens. Mentoring and sponsorship opportunities also help to make radiologists feel welcome, included and valued, they added.
“Ultimately, mentorship and sponsorship allow mentees, mentors, and their organizations to achieve purpose and fulfillment—a win-win for all.”
8) Providing strong and visionary leadership: In this challenging climate, the specialty desperately needs individuals to steer the ship. This will require initiating difficult conversations with hospital administrators and government officials, collaborating both within and outside of radiology, and addressing structural issues that make the profession vulnerable.
“Radiology has just weathered a perfect storm: a toxic brew of pandemic, reimbursement cuts, devastating inflation, increased work demands, social and healthcare disparities, supply chain disruptions, and now both a ‘great resignation’ and ‘quiet quitting’ from work,” the authors wrote. “Leaders must recognize the currently unique and challenging situation and prepare to think and act differently.”
Read much more in the Journal of the American College of Radiology below.
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.