If there is one point of consensus among all radiologists, it is that the specialty is facing a severe personnel shortage. But there is debate as to whether the shortage is abating. A recent study published in the February issue of the American Journal of Roentgenology (AJR) indicates that the shortage is trailing off. “We’ve identified about 10 phenomena that might contribute to the easing,” says lead author Jonathan Sunshine, PhD, senior director for research at the American College of Radiology (ACR). “The ACR is undertaking studies that will provide detailed information on how important in fact each of those is.” The authors drew their conclusions by looking at the number of vacancies in academic radiology departments, the ratio of radiology job listings to job seekers reported by the ACR’s professional bureau, radiologists’ self-reported workload burden, and the job listings in the AJR and the journal Radiology .
Though the authors conclude that the crisis is easing, the study shows that the shortage is continuing. According to the survey, in 2003, vacancies per academic department averaged 3.9, compared to 5.4 in 2001 and 5.1 in 2002. The listings per job seeker dropped from 3.0 or more in 1999 and 2000 to 1.4 in 2002.
Not everyone agrees that the shortage is abating. “There may be a problem because some practices may have been looking for a long time and have just quit advertising in [the ACR journal],” says Charles Williams, MD, FACR, chairman, Department of Radiology, Tallahassee Memorial Hospital, Tallahassee, Fla; member of the ACR Board of Chancellors; and chair of the ACR Commission on Human Resources. “Some people may have been going from print media to electronic media for advertising jobs. And people may be going to headhunters, so I don’t know if we can just use the journal advertisements for monitoring the shortage in this electronic day and age.”
According to a paper by Forster et al published in the April 2004 Journal of the American College of Radiology (JACR), a recent report estimated the deficit at 5% and projected that it could grow to 50% by 2020, a number greater than 15,000, as demand increases more than supply.
“The Baby Boomers are coming on boardand when people are above 65 years old, they receive four times the number of tests as others receive,” comments Williams.
The shortage is being most felt in rural areas as opposed to large urban centers, because, says Lawrence Muroff, MD, FACR, president of Imaging Consultants, Tampa, Fla, the urban environment is a more desirable place to live for many radiologists. “I think that’s always been the case and probably will always be the case, unfortunately,” he says. “[However,] if you want to generalize, the shortage is affecting everybody.”
Robert L. Bree, MD, MHSA, radiologist and medical director with Radia Medical Imaging, Everett, Wash, has seen the rural shortage first hand. The 50-radiologist group, itself experiencing shortages, has been offering remote coverage to rural hospitals throughout the region.
The crisis in rural areas is getting worse, says Kevin Forster, MBA, MHA, senior manager, ECG Management Consultants Inc, Seattle, but there is another problem that may be fueling this particular problem. “What the rural hospital needs is somebody who can read and who is interested in reading several modalities as opposed to a neuroradiologist who focuses solely on MRI, and more and more it’s becoming harder to recruit a general radiologist,” he says. “And [rural hospitals] often don’t have the ability to offer the same ancillary revenue opportunities that some of the urban settings do.” In the JACR article Forster coauthored, he noted another alarming trend. Since 1996, the number of radiology residents in training has decreased by more than 11%.
According to Sunshine, there is no one subspecialty that is experiencing a particular crisis. The reason simply has to do with the way in which residents and fellows make specialization choices. “[In an earlier study], we found typically that a field that was in shortage one year wasn’t the field that was in shortage the next year,” he says. “We haven’t tracked that in the last few years, but my belief would be that the same pattern of shifting occurs. And it probably occurs because residents are smart people, and when they hear what is the hot field, they concentrate in fellowships in that field, and then that helps relieve the particular shortage in the field.”
But it is not just office- and hospital-based radiology groups that are experiencing shortages. Academic radiology has become a fertile source of new blood for groups, which is thinning its ranks. This trend troubles Williams. “[Academic departments] are pretty much short and they’re having to work harder, and we don’t want the seed corn to dry up because that really would hurt the shortage,” he says.
Even with the debate as to the severity of the radiologist shortage, groups are still struggling to recruit and retain members, necessitating new and more effective ways to attract new hires or find better ways to make do when none are available.
RECRUITING NEW BLOOD
Forster says that the problem with recruiting today is that many radiologists are more particular about what they want, which could mean more money or other, nonfinancial, quality-of-life benefits, which could include things such as no night or weekend coverage duties. “The best way to ease a shortage is to make your practice more desirable than someone else’s in comparable circumstances,” says Muroff. “So, if you are recruiting somebody, you have to have an edge in hiring that individual.” For instance, he says, the time to partnership can be shortened and the partnership buy-in can be lower than a market competitor’s.
Forster sees the hospital as a partner in helping to alleviate staffing woes. He advises a number of ways for hospitals to assist groups in making their practices look more attractive. These include increasing the number of medical directorships, investing in new technology such as a picture archiving and communications system (PACS) and updated imaging equipment, increasing the amount of administrative support to the radiologists, and redesigning reading rooms. “Too often, you find radiologists frustrated with the lack of attention from an operations standpoint to issues that slow down the radiologists,” he says. “Paying attention to those details can go a long way for both the hospital and the group. When it is recruiting radiologists, the group can say, This is a great environment, our needs are addressed, we’re not ignored.'”
Another quality-of-life requirement, which could be a reason why rural practices are having a tough time recruiting, is allowing radiologists to work exclusively in their subspecialty area, as opposed to reading several modalities.
There are financial incentives that can work as well. For instance, Williams says that his group took a cue from the United States Air Force and has assisted fellows financially in training with the understanding that they will be a part of his group.
For Bree’s group, Radia Medical Imaging, the issue of recruitment is such a serious one that it appointed one of its members as recruiting director, who is given time away from his imaging duties to actively recruit new hires. When a potential hire comes to town, they are given as warm a welcome as possible. “We treat [the interviewee] as an honored guest, whereas we didn’t do that very well in the past,” says Bree. “We try to identify for them in advance what they’re going to do, where they’re going to work, and where we suggest they live.” And it is a system that is bearing fruit. Radia just recruited seven new radiologists to the practice. For leadership positions, however, it uses an executive search firm.
Unfortunately, finding a qualified radiologist is only part of the solution for personnel-strapped groups. Keeping them is the other part of the equation.
RETAINING THE NEW HIRE
Muroff says that because there is more mobility in radiology with physicians leaving a practice for a variety of reasons ranging from the voluntarya better offerto the involuntarybeing firedgroups are in flux more than they used to be. And no matter how attractive a group has made a starting salary, keeping a radiologist may involve more than money. “I would say that [nonsalary] issues are more compelling draws than absolute dollars,” says Muroff. “A rural practice might be able to pay more, but it might not have the cultural or sports attractions, rounded quality of life that might be important to a radiologist and his or her family. Sometimes keeping the family happy is far more important.” Muroff adds that the one setting where money is an issue is academia, where pay compared to work is substantially less than in private practice.
Going hand in hand with its recruitment efforts, Radia also has developed a retention strategy, which includes a mentoring and orientation program and the opportunity to become a partner.
Forster notes how important it is to retain new and old members of a practice. “From a retention standpoint…groups operate at a level where there is not a lot of excess capacitythey are trying to maximize their income, obviously,” he says. “If they lose one person…it tends to have a snowball effect unless it’s corrected quickly…because all of a sudden, the balance has shifted even more, and you are working longer hours, and a lot of these guys aren’t looking to make more money, they’re looking for balance in their life.”
The answer to personnel woes is not always finding a new radiologist. There is another way to leverage the existing manpower to compensate for the lack of new personnelbecome more efficient.
A PARTIAL SOLUTION: EFFICIENCY
Technology is one way to allow hardworking radiologists to become more efficient, and PACS is probably the number one way to achieve this. “This is important because many radiology practices are very inefficient with radiologists driving from place to placein other words, the radiologists chasing the films instead of the films coming to the radiologists,” says Muroff.
Bree notes that Radia, which serves numerous locations throughout the state, is in the process of centralizing its reading area.
But technology is not the only way to solve the radiologist shortage. The newly created designation of radiologist assistant (RA) could help alleviate it. The first class of RAs will graduate in 2005, but Williams, who has been leading the charge on the creation of this new designation, is enthusiastic about its potential. “This is a twofold thingit’s a career ladder for the technologist, which will attract more of them, [and] it allows the radiologists to increase their productivity and efficiency and concentrate on some high-end items,” he says.
Making practices more attractive to potential hires and more efficient for the radiologists onboard is the short-term solution. There are long-term strategies that could greatly alleviate the burdens facing radiologists today.
A SOLVABLE PROBLEM
Williams, Bree, and Muroff all see part of the long-term solution for the shortage in increasing funding for academic residencies and fellowships. “[This] may require legislation for certain specialties,” says Williams. “But the problem is what went on with 9-11. If it doesn’t have to do with security, it’s hard to get funding. [The shortage] may have to get worse before it gets better in order to get the funding.”
Forster sees the problem as one that could be solved both technologically and by changing the way groups do business. “Technology is going to help disseminate the workload more evenly,” he says. “I think over the long term, you’re going to see greater business relationships across radiology groups even if it’s just for overflow coverage.” According to Forster, outsourcing will become more and more common as both a short-term and long-term answer to group shortages.
Sunshine agrees that much of the solution will be dependent on hownot how manyradiologists are working. “The number of procedures per radiologist is increasing, and I think everyone is feeling busier and, as a result, somewhat grumpier than they used to,” he says. “I hope that it’s pushing radiology groups to focus on how they can work smarter, which is to say, get more work done in the same amount of time without being more out of breath. The possibilities of working smarter range from the highly technological such as PACS…to the purely organizational.”
No matter how the problem is solved, whether it is through increasing the number of radiologists or using that new magic bullet, PACS, to create greater efficiency, or some combination of both, this is not the first time radiology has faced a manpower crisis, and may not be the last. “Back in the late ’60s, medicine was 50,000 physicians short, and that time they doubled the number of students in medical schools,” says Williams. “I think this could be greater than in the past, because the examinations are becoming more complicated. They require more effort, more time, more energy. In the ’70s, we went through it because there were advances in the equipmentlike CT and ultrasound.” He predicts that it could take at least 5 or 6 years after the solutions are in place before the problem really starts to abate.
Part II, on the Technologist Shortage, will appear in the July issue.
Chris Wolski is associate editor of Decisions in Axis Imaging News.