Radiology departments are not only facing severe shortages of radiologists: a similar shortage of radiologic technologists is contributing to the challenges of meeting patient demand, and remaining efficient and profitable.

But as with radiologists, the problem may be abating, according to Lynn May, CEO, American Society of Radiologic Technologists (ASRT), reflected by the fact that more people are entering training programs and the number of advertisements for radiologic technologists is dropping. This is the good news, but May cautiously notes that the radiologic technologist shortage is a problem that has been and will probably always exist. “My own feeling is that there is sort of an ongoing shortage all of the time,” he says. “Long term, I think there’s definitely going to be a need for more technologists. Short term, we may be seeing some abatement of the shortage. That’s a question mark, because I really don’t know other than anecdotal, incidental information.” Noting how big the problem may be long term, he adds that, according to the US Bureau of Labor Statistics, there will be a need for 100,000 radiologic technologists over the next 10 years.

Though radiology departments and imaging centers will simply have to learn to live with the radiologic technologist problem, there are a wide variety of strategies and tools available to effectively alleviate the problem. These strategies include aggressive recruiting of technologists with bonuses, relocation allowances, chances for advancement, and competitive salaries. Some organizations are also affiliating with and helping to fill the ranks of the radiologic technologist training programs. Finally, the ASRT and the American College of Radiology (ACR) are optimistic that the new radiologist assistant designation will create the kind of career ladder that will help to both attract and retain more radiologic technologists.

Though educationthe creation of both new radiologic technologist and radiologist assistant programsis part of the long-term solution to the shortage, novel recruiting methods are necessary in the short term to cope with ongoing needs, particularly those created by ever-expanding practices and departments.


It was expansion that recently caused several openings at Radiological Associates of Sacramento Medical Group Inc, Sacramento, Calif. The practice’s recruiter, Patti Tejes, was given latitude to be creative and a mandate to recruit only the top talent to fill the four positions. This meant that Tejes had to discover what motivated each of the potential candidates. She discovered that it was not always money. “Individuals want an opportunity for growth, they want an opportunity to learn new things,” she says. “So one campaign I tried a couple of months ago was to advertise and talk a little about coming to Radiological Associates and learning something newMRI and CT. We had four successful hires from that locally.”

Figure. The number of first-time candidates taking the primary technologist examination has grown significantly over the past 3 years, according to data from the American Society of Radiologic Technologists. But demand is expected to continue to outstrip supply.

Though Tejes says the 52-radiologist practice is fortunate that there are several technical schools to cull recruits from, she has recruited technologists from all over the United States and Canada. The practice offers sign-on bonuses and relocation. In addition to recruiting, the practice also uses advertising in both print and on Web sites, and current employees to refer potential hires.

Instead of offering sign-on and other types of bonuses, the Ochsner Clinic Foundation, New Orleans, has created a work environment where employees feel valued, paying a competitive salary that changes to meet the demands of the market. “We found that when we [offered bonuses], the technologists who were [already] working for us resented the fact that they were loyal and hadn’t left, and we were giving a hiring bonus to someone who had left and came back. That caused a lot of unpleasantness,” says Edward Bluth, MD, chairman of the Department of Radiology at Ochsner. “We felt that it was better to pay our technologists at an appropriate level.”

Ochsner also has a crew of per diem employees who cover for a variety of reasons including vacations and to fill any openings short term.

But recruitment is not always a question of looking at immediate needs. Many practices are looking long term, recruiting potential technologists while they are students.


When Dartmouth-Hitchcock Medical Center, Lebanon, NH, eliminated its film library, it gave the librarians the opportunity to enter a 2-year American Medical Association-approved radiologic technologist course at nearby Lebanon College. Five of the staff took advantage of the program and were loaned the $17,000 tuition by the hospital, which gave them part-time jobs to keep them eligible for health benefits. The hospital credit union loan will be forgiven by a third for each year the new radiologic technologists work at Dartmouth-Hitchcock. The five ex-film librarians, plus two other employees, soon will be graduating and are expected to join the staff in September 2004.

Monte Clinton, CRA, director of radiology at Dartmouth-Hitchcock, explains that the hospital’s motivation to offer this opportunity was not purely altruistic and not spurred by any guilt associated with getting rid of the film library. “The reason we did this is because we were having a tough time getting radiographers to come and work in northern New England,” he says. “So we thought that by recruiting people who already lived up here and liked it, we would have a stable workforce, plus we were doing something for the community.”

Dartmouth-Hitchcock, which has been converting to a fully digital array of imaging equipment, has supported the Lebanon College program with more than students. It also donated two analog x-ray suitesone a live and one a practice setupto the school.

Once the seven students graduate and join the staff at Dartmouth-Hitchcock, they will take entry-level positions in plain radiography, allowing senior technologists to promote to more complex modalities. These seven new technologists will alleviate the personnel shortages that the radiology department is currently experiencing.

In addition to Dartmouth-Hitchcock, seven other hospitals in Vermont, New Hampshire, and Massachusetts are taking part in the Lebanon College program, sending employees to it for training.

Ochsner has a radiologic technologist school on its campus, which Bluth describes as its farm team, and from which it can recruit new employees.

Radiological Associates of Sacramento Medical Group has a speakers bureau of 45, which puts on 35 presentations a year at local high schools, colleges, and technical schools. In addition, the practice developed a scholarship program 2 years ago, which, in addition to assisting with tuition, provides a small monthly stipend to the students, and the opportunity to work for the group once they graduate. “What we’ve tried to do is create a pipeline, where kids in high schooljuniors and seniorsare thinking that the medical field isn’t just about nursing and becoming a doctor,” says Tejes.

But recruiting, no matter the method, is not enough. Organizations also have to find a way to keep their technologists.


No matter the specific method used to retain technologists, Tejes advises that there is one overriding principle necessary to keep technologists happy. “You need to be honest with the candidate,” she says. “You need to say this is what we can provide and you better be certain that’s the environment you can offer them.”

In most cases, retention has to do more with quality of life issues than money. At Dartmouth-Hitchcock, there is a myriad of ways in which the administration works to retain its technologists. For instance, shifts are tailored to meet the needs of the employee, including 4-day work weeks. “We do a lot of accommodating of work shifts,” says Clinton. “We’re very flexible in trying to help [our technologists]. It’s important that the employee have a good home life. So, a lot of times, all that we have to do to make a positive impact on their home life is to adjust the work day to fit their schedule.” This flexibility comes in addition to good benefits, which include 5-weeks vacation, on-site parking, day care, subsidized meals, and health benefits.

Quality of life is not just a matter of flexible schedules and subsidized meals at Dartmouth-Hitchcock. Wages are also competitive, based on those paid in nearby Boston.

In addition to creating a good work environment, Radiological Associates of Sacramento Medical Group implemented a recognition program that culminates in a yearly gala for the group’s 850 employees. At this event, longevity is recognized, and other outstanding employees receive gifts ranging from certificates to cash awards.

Dartmouth-Hitchcock also has a recognition program, “Stars of Radiology”, that has patients nominate deserving technologists.

Since Ochsner does not have a bonus system, Bluth says, it continuously reviews its pay scales, maintains a good working environment, and makes sure the technologists are not overworked, have opportunities for promotion, and the ability to earn continuing education units.

In addition to being honest with employees, Clinton says there are a number of other principles that groups should keep in mind in their efforts to retain employees. “I think some of the more important things are treating employees with respect, keeping them informed, and asking their opinions. And if things need to change because they’ve brought things to your attention, then change them,” he says.

To aid both recruitment and retention, the ASRT has put together an online tool kit of strategies and case studies. Retention advice ranges from the obviouspay good wagesto the innovativemake room for fun, hire RT aides, and provide a variety of assignments.

But these are not the only ways to help to attract and retain technologists. There is another method that the ASRT and ACR hopes will alleviate the shortagethe radiologist assistant.


In May 2003, the ACR accepted the proposed list of responsibilities for the radiologist assistant, which includes performing patient assessment, patient management, and selected examinationssuch as obtaining clinical histories, assisting the radiologist with invasive procedures, and performing fluoroscopy for noninvasive proceduresunder the supervision of a radiologist. The radiologist assistant will perform no interpretations, but can make initial observations, which they are allowed to share with the supervising radiologist.

The radiologist assistant will have to seek certification from the American Registry of Radiologic Technologists (ARRT) after completing a baccalaureate or postbaccalaureate degree. Several schools have been approved to offer a radiologist assistant curriculum, including Loma Linda University, Midwestern State University, the University of North Carolina at Chapel Hill, and the University of Medicine and Dentistry of New Jersey.

Even with a variety of tools available to practices and radiology departments, there is one big pitfall to avoid when trying to fill spots. Tejes says that sometimes when recruiting to fill a staffing hole, organizations are simply content to plug it. She advises against this. “That can be very costly and time-consuming to fix,” she says. “There are good people out there. It’s just taking time to uncover those folks.”


The American Society of Radiologic Technologists (ASRT) has created a recruitment and retention tool kit that is available on its Web site ( ). Among the tools are recruitment and retention tips, links to resources, and wage and salary guides. Access the tool kit at: . A user account is not necessary to access the tool kit.

Chris Wolski is associate editor of Decisions in Axis Imaging News.