Without overstating the obvious, the shortage of professionals in the medical imaging field is real,” says John Moberly, VP of Med Travelers (Irving, Tex). The factors are numerous and not easily altered. In addition, new human resources are not readily available. Training of medical-imaging professionals can range from 2 years for technologists to more than 10 years for radiologists. Nevertheless, medical-imaging facilities can find relief in technology. Digital imaging hardware and software help to improve workflow and throughput, while improved technologies are making teleradiology an option for many.
Demand Exceeds Supply
Increased demands have compounded the nationwide shortage. Longer life spans and an aging population are creating more need for services, while technology contributes to the workload by increasing the amount that can be done.
At the same time, enrollment in technologist and allied professional programs continues to be low?slightly improved but still low?while fewer residents choose to specialize in radiology. Some are motivated by an interest in subspecialties; others are driven away by logistics?malpractice risks and costs tend to be higher in radiology than in other disciplines.
With the aging radiologist population choosing to retire early more frequently, the supply of new radiologists will not be enough to replace those leaving the field, exacerbating the shortage.
“Any MD specialty takes a great deal of time to replenish the supply. It will be 10 to 20 years before things will be close to OK,” predicts Mark Bakken, president and co-founder of The Radlinx Group (Irving, Tex). Unfortunately, it might be even longer for hospitals located in rural areas or those that require only one or two radiologists.
Recruitment and Retention?Not About Money
“A solo radiologist is on call 365 days a year, so it is difficult to convince them to come on board,” says Bakken, who notes that while retention is difficult, recruitment is even harder?particularly for rural hospitals with 8,000?15,000 studies per year.
Residents do not want to take call, and, in fact, they expect not to take it. “Money is a minor factor now. Physicians are more concerned about quality of life. So residents are no longer asking if they have to take call but rather who will be covering call.
Opportunities abound out there for them to find the job that suits them,” Bakken explains.
Opportunities also exist for technologists and other allied professionals, particularly those with experience. “The department manager or director is always looking for a degree of experience in handling caseload,” Moberly says, adding, “New techs also are experiencing opportunities for better upward mobility, though hiring managers should be sure not to put someone in a position they are unprepared for.”
Recruitment, however, is only the first challenge. Retaining good people is the second. The best way to achieve a high retention rate, according to Moberly, is to take care of the personnel currently in the department. “Staff must be able to effectively communicate with facility management, and executives should emphasize people as their number-one resource. Happy employees can provide positive testimonials?referral is one of the strongest measures of recruitment,” Moberly says.
Another potential source for recruitment is new programs for radiology practitioner assistants (RPAs). “These new professionals can perform basic readings of plain film and are intended to alleviate the volume read by radiologists,” Bakken explains. “Although programs are increasing in number, there are not very many, RPAs are not yet in the market, and some members of the medical community question RPAs’ ability and value.”
Technology Steps Up
If new human resources cannot fill the gap, it is only natural in today’s world to turn to technology. And it readily comes to the rescue. New medical-imaging systems have improved workflow and throughput so that facilities can handle greater patient volumes with available staff. These include hardware, such as faster CT scanners, and software, such as PACS and CAD.
“CAD is currently used primarily in mammography, where it does not replace the radiologist but helps physicians to work faster and more effectively,” Bakken says.
A more popular solution than CAD, however, is teleradiology, which allows a radiologist to read images remotely. “Virtual radiology has been a hard corner to turn. Many facilities, particularly those offering multi-subspecialties, do not want to give up on in-house radiology because not only is it helpful, it also is a source of revenue. However, for organizations with no other option, teleradiology is a viable solution,” Bakken says.
He notes that with the ability to digitally move images anywhere, 90% of hospital radiology needs do not require the radiologist to be on-site. “Many hospitals are giving up on the 10 percent that requires on-site intervention,” he says. “I expect that off-site radiology will be standard in 10 years.”
Before developing teleradiology programs, facilities will need to be sure that they:
- have access to broadband, which might be a challenge in rural areas;
- can produce digital images, whether captured in a digital format or done so traditionally and digitized later;
- have readers who are licensed in the facility’s state; and
- have appropriate malpractice insurance.
“The biggest hurdle is getting plain film into digitized format?75 percent to 80 percent of all images are still X-rays,” Bakken says.
But licensing, credentialing, and malpractice are issues that also must be addressed. Bakken advises that malpractice insurance specifically covers teleradiology over state lines. “Originally, Radlinx had to go to Lloyd’s of London for insurance because it was so new, but it has become more standardized since then,” he remembers.
Bakken also suggests that hospitals work only with radiologists based in the United States. “It’s a liability issue. If that person has a misread, the complainant is not likely to deal with jurisdictional issues and will instead list the facility that hired him or her.”
If finding people at any level becomes too great a challenge, organizations can turn to staffing agencies to provide radiologists, technologists, or other allied professionals to meet a hospital’s needs?from full-time to teleradiology to weekend coverage. Some agencies specialize, so facilities should be able to find services that match specific needs.
Med Travelers, for example, matches independent contractor imaging technologists and therapists to hospitals and other facilities across the country. Radlinx supplies off-site radiologists who work full time; it’s also possible to find part-timers. “There is no cookie-cutter method right now. Healthcare markets don’t change really fast, but maybe in 10 to 15 years,” Bakken says.
When evaluating an agency, clients should ask the following questions:
- How long has the agency been in business?
- What services does it provide, and in which geographic regions?
- How are its departments organized? (Those organized by specialty might be more efficient.)
- How many recruiters will be assigned to the account?
- What is the prequalification process for candidates that the agency recruits?
- What types of references are required, and will the agency check them?
- What are the agency’s standards for itsrecruits?
- How does the process work? For instance, does the agency provide a candidate’s background before any interviews?
- Does the agency ensure adequate job performance and customer satisfaction byconducting follow-ups?
- Can the agency provide references that include current clients willing to speak freely?
References by current clients can provide insight into whether an agency can adequately meet a facility’s needs, while references for the candidates can provide insight into the prequalification process. “Different agencies have different policies,” Moberly says. “We ask for references from managers and supervisors [with whom the candidate] worked over the past year. For students, we request the clinicals instructor. We have a third-party objective department to conduct references, so no bias is involved. This same department calls after a job has been completed to verify performance and satisfaction. Customers pay a premium price and expect a premium product.”
But what about the staff? What can they expect? Neither Moberly nor Bakken have found regular aspects about which employees complain, unless it is patient care. “Many people enter the field to help others. The current personnel in a quality department are, therefore, usually concerned about providing the best-quality care to patients. If the department is not properly staffed, staff members might feel pressure providing that care,” says Moberly, citing packed schedules and long wait times as negative patient factors.
He suggests that departments typically determine how to manage the effects on patient care before they are felt, including whether to bring in additional personnel, even if only temporarily. “The effectiveness of diagnosis and treatment has improved. Facilities just need more staff,” Moberly says. In the meantime, better technology can help.
THE LONG AND SHORT OF IT
Many facilities, particularly small and/or rural operations, find it difficult to recruit and retain staff in their medical-imaging departments. What to do?
Renee DiIulio is a contributing writer for Medical Imaging.