The 7 most pressing challenges in radiology practice: A ‘perfect storm’ is brewing
Leaders from 31 different radiology societies recently met, devising a list of the seven most pressing challenges facing radiology and solutions to address them.
Members of the American Society of Radiology Intersociety Committee convened Aug. 4-6, 2023, in Coronado, California, to discuss a range of issues related to the specialty. They shared their work Tuesday in JACR [1], noting that rads are grappling with consolidation, corporatization, staffing shortages and more, all combining to create a challenging business climate.
“Taken together, a ‘perfect storm’ of pressures on radiologists and their institutions is brewing,” lead author Bettina Siewert, MD, a professor of radiology at Harvard, and colleagues wrote Oct. 29. “Solving these issues will not be easy; this is a collection of ‘wicked’ problems defined as having (1) no stoppable rule, (2) no enumerable set of solution or well-described set of permissible operations, and (3) stakeholders with very different worldviews and frameworks for understanding the problem.”
Here is a quick rundown of the seven biggest challenges facing radiology practice in the United States (and possible solutions):
1. Declining reimbursement: Radiologists performed 13% more RVUs per Medicare beneficiary in 2021 compared to 2005. At the same time, the inflation-adjusted conversion factor fell nearly 34%. This resulted in rads sustaining a 25% decline in adjusted reimbursements per beneficiary.
As a solution, the groups suggested that medical societies continue to lead efforts to minimize reimbursement cuts.
“Radiologists are advised to join professional organizations to support this important work. Other efforts include adjusting reimbursement to case complexities,” the authors wrote.
The writers also highlighted the lack of compensation for noninterpretative services as a key component of this concern. Radiologists often must handle a high volume of tasks outside of clinical work, with no corresponding payment. As one example, a recent study found that faculty members devote about 48 hours per year to multidisciplinary conferences with no related reimbursement.
Other noninterpretative tasks may include teaching, mentoring, consultation, scheduling, accreditation and marketing. The authors suggested forming a coalition of stakeholders to begin addressing this problem.
“Radiologists should seek compensation from hospitals for these critical noninterpretive services,” the authors wrote. “As payment transitions from a transactional procedure-based system to a value-based system, radiologists must be actively engaged in establishing and quantifying metrics for these services to assure appropriate compensation.”
2. Corporatization and consolidation: This trend reduces the choices radiologists have for work opportunities, especially in private practice. Corporatization often changes the role of a physician from full owner to holding no such stake and potentially serving as an employee, the authors noted. Conservatively, about 10% of the American radiology workforce is employed by entities created by third-party investments.
To address this, Siewert et al. suggest schooling radiologists about the pros and cons of consolidation and corporate ownership. Some physicians also may pursue unionization in certain settings.
“For academic practices, preserving the academic mission, including research and education, is critical,” the authors wrote. “The next generation of radiologists depends on the educational investments of the current generation. Some academic institutions will probably merge to form larger hospital networks and will also likely continue to build alliances with community practices.”
3. Inadequate labor force: Staffing shortfalls are likely to persist and may even worsen, with training programs failing to keep pace with attrition and surging demand.
The authors suggested several solutions, including creating residency positions in private practices, tapping international medical graduates, and increasing job flexibility.
“To maintain involvement of senior physicians in clinical care and fulfill expectations of recent graduates, organizations need to provide flexibility in scheduling clinical work through part-time positions and remote work,” Siewert and co-authors wrote. “Additional initiatives include engagement of both parties in mentorship programs as mentors and mentees.”
4. Imaging appropriateness: There is a growing gap between the current service capacity in radiology and the rapidly increasing demand for imaging in the ED and elsewhere. Numerous factors are driving this mismatch, among them, clinicians’ increasing intolerance of diagnostic uncertainty and growing use of nonphysicians, who order imaging at higher rates.
Experts stressed the importance of targeting imaging overutilization to remedy this supply-demand mismatch.
“To facilitate this reduction, better data on imaging outcomes for specific clinical questions are urgently needed,” the authors wrote. “Considering the magnitude of the mismatch crisis, radiologists may also need to consider expanding their consultative role to include that of a gatekeeper, as is done in other more resource-controlled countries.”
5. Burnout: About 78% of radiologists surveyed said they are reading at volumes exceeding their capacity, one study found. Heavy workloads may be endangering the quality of patient care and propelling radiologists to switch jobs or leave the profession altogether.
The societies suggested using listen-sort-empower methodology to identify solutions for addressing burnout.
“Engaging team members in a conversation about the causes for dissatisfaction can help identify local opportunities for improvement,” Siewert and co-authors noted. “Using a team approach based on the concept of listen-sort-empower, burnout can be combatted by fostering free discussion between frontline workers and radiologists. Facilitators unaffiliated with the radiology department can help to maintain focus on gratitude for positive attributes of the work and the institution as well as to keep the sessions on task and prevent them from devolving into complaint sessions with a subsequent loss of hope.”
6. Turf wars with nonphysicians: Interpretation of imaging exams by nonphysician providers has increased by upward of 30% over the last five years. About 31% of this occurred in major metro areas in which rads are plentiful. NPPs have seemingly been busiest in states with lax scope-of-practice laws, with some exploring opportunities to compete directly with radiologists.
Experts believe addressing this challenge will require increased advocacy about the importance of physician-led care.
“The field of radiology must generate evidence of the value of radiologists by effectively delivering the message that the person who interprets an imaging study or performs an image-guided procedure matters. The targets of this messaging would include legislators, the public and hospital administrators. One particularly critical target would be hospital bylaws: Hospital medical staff need to present a united front on this matter, which is the equivalent of scope-of-practice legislation but at the hospital level.”
7. Increase workflow efficiency: Radiologists spend as little as 36% of their time on image interpretation, previous studies have found. Possible solutions might include delegating noninterpretive tasks to nonphysician team members, incorporating AI into workflows, and improving the design of reading rooms.
“Optimizing sound absorption and using headsets can reduce unintentional interruptions from ambient noise generated by adjacent personnel. Background music has been shown to enhance concentration and increase productivity. However, there are certain caveats—the music should be instrumental only (no lyrics) and of a genre that the listener enjoys.”
You can read our coverage of last year’s intersociety meeting report here and find the full report 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.