Fewer radiologists are interpreting breast imaging exams, with key workforce implications
The number of radiologists performing breast imaging services has fallen over the last decade, with potential implications for workforce planning, according to new research published Monday.
From 2013 to 2022, the percentage of all rads submitting breast care claims to Medicare dropped from about 47% down to 34%. Meanwhile, the proportion of subspecialized radiologists—specifically trained in breast imaging—increased from 8% to 13%, researchers detailed in JACR.
In fact, the majority of breast imaging exams across all modalities were handled by breast radiologists as of 2022, reflecting the profession’s growing subspecialization.
“This centralization suggests an evolving role of generalists versus specialists and poses important implications for potentially advancing quality of care and informing access, education and workforce considerations,” corresponding author Richard E. Sharpe Jr., MD, MBA, chair of breast imaging at the Mayo Clinic, Phoenix, and colleagues wrote Nov. 3.
The study utilized all outpatient imaging claims for the Medicare population, logged over a decade. Radiologists who dedicated more than 50% of their case mix to breast imaging were defined as subspecialists. Between 2013 and 2022, breast imaging-related work relative value units (wRVUs)—used to measure a physician’s productivity—increased by nearly 8% annually. Meanwhile, the number of radiologists performing breast imaging services decreased by about 2% annually.
Sharpe and colleagues found that a decreasing number of radiologists are interpreting breast imaging exams, potentially driven by multiple factors.
“This could in part result from decreases in the radiologist workforce due to aging and retirement,” the authors speculated. “Another contributing factor may be the increasing complexity and regulatory demands of [breast imaging], including Mammography Quality Standards Act requirements for initial and ongoing certification, which may disincentivize participation by general radiologists.”
Conversely, the number of specialized breast radiologists submitting claims for breast imaging services increased by about 7% annually during the study period. At the same time, the percentage of all radiologists who were breast subspecialists (spending over 50% of their time in this care segment) increased from about 8% in 2013 up to 13% at the end of the study period. Breast imaging work RVUs also increased about 15% annually.
Starting in 2017, more breast imaging wRVUs were performed by subspecialized breast radiologists than other generalist radiologists. In 2022, the fraction of breast imaging services provided by breast imaging subspecialists varied by modality, the study found. For instance, such subspecialists handled about 64% of mammography exams, 70% of breast ultrasound, 81% of MRIs and 83% of interventional procedures.
“The growth in the percentage of all radiologists who are subspecialized in [breast imaging] may have several contributing factors,” Sharpe and colleagues noted. “The formalization of national fellowship curricula, increased awareness of preferable work-life balance in [breast imaging], continued technological advances in [breast imaging], an increasing ability to concentrate one’s practice within [breast imaging], the varied work tasks, as well as patient contact, may continue to attract increasing numbers [of] radiologists to the subspecialty.”
Sharpe and colleagues believe these trends could bear fruit for patients and referrers. Previous studies have shown that subspecialized breast care can improve cancer detection rates, reduce the number of recalls, and improve interpretation of outside images. They believe ongoing monitoring is needed to balance specialization with “equitable access,” ensuring disadvantaged populations benefit from subspecialization. Further research could assess how the shift away from generalist breast imaging care impacts quality.
“Increasing growth of subspecialized breast radiologists implies a need to nurture a future pipeline of subspecialized breast radiologists to support future demand,” the authors wrote. “These findings can potentially inform radiology practices seeking to retain subspecialized breast radiologists,” they added later. “Specifically, this cohort of radiologists may desire contracts and assignments predominantly focused on [breast imaging] work. Aligning training capacity with workforce dynamics will be critical to meet future needs.”
Read much more, including potential study limitations, in the Journal of the American College of Radiology.
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.