Increased reliance on imaging for diagnosis and efficient patient care mixed with higher volumes of patients has left hospitals scrambling to meet demand with the few radiologists they have.
There are over 1,400 vacant radiologist positions posted on the American College of Radiology's job board, according to a bulletin posted on its website. The total number of active radiology and diagnostic radiology physicians has dropped by 1% between 2007 and 2021, but the number of people in the U.S. per active physician in radiology grew nearly 10%, according to the Association of American Medical Colleges. An increase in the Medicare population and a declining number of people with health insurance adds to the problem.
"Demand for imaging services is increasing across the country, creating longer worklists for radiology staff at the same time the healthcare system is experiencing a workforce shortage in radiology," Michigan Hospital Association CEO Brian Peters told The Detroit News in an April 28 report. "The combination of vacancies and increased demand can force imaging delays measured from days to upwards of two weeks."
CMS also cut fees for both diagnostic (3%) and interventional radiology (4%) this year, according to an article published on healthcare technology company XiFin's website. This leaves many hospitals having to use external groups to stay on top of demand.
Mr. Peters told Detroit News, "Hospitals and health systems are also competing with practices offering remote-only positions, which allows Michigan radiologists to work for out-of-state providers at higher rates."
Some states struggle more than others
Massachusetts has the highest number of employed radiologists in the country with 3,300, according to the most recent Bureau of Labor Statistics data. It is followed by California, New Jersey, New York and Texas. Meanwhile, seven states have a total radiologist employment of 40-90: Alaska, Hawaii, Louisiana, Montana, South Dakota, West Virginia and Wyoming.
Even with higher rates of radiology employment in their states, some systems struggle to stay on top of demand.
All but two hospitals in Michigan report having a shortage of radiologists and delays in imaging, Detroit News reported. Corewell Health and Henry Ford said their radiology staff is 10% below optimal levels, but they are covering the shortages by recruiting locally, offering more resident slots and giving existing radiologists the option to partially work from home.
Southern California also struggles to keep radiologists, in part due to having one of the lowest reimbursement rates for the specialty in the nation, but also due to competition with remote work opportunities, XiFin said. Out-of-state companies can offer higher compensation and remote work, thus pulling physicians away from the local market.
Solutions
Experts point to three solutions to ease the shortage: Getting more medical students into the field, utilizing artificial intelligence and providing more work-from-home opportunities.
The number of first-year radiology residents and fellows dropped 7.2% between 2016 and 2021, according to the AAMC. However, radiology appears to be one of the most competitive specialities with no shortage of interest, according to the 2024 national residency match program. In 2023, there were 1,006 residents matched into diagnostic radiology and 123 into interventional radiology, with 100% of positions filled, according to the American College of Radiology. One resident told Detroit News that there are more residents interested in radiology than positions available.
The gap comes from hospitals and health systems offering fewer slots for radiology. Hospitals are capped by the total number of residents they can bring on, which often means those slots are given to more general specialties, the American College of Radiology bulletin said. In 2022, the American College of Radiology urged CMS to allocate radiology positions in rural areas. In July 2023, an initial 200 positions were directed to primary care and mental health services, with only six positions added for diagnostic radiology and 3.23 positions for interventional radiology, the association said.
Some systems have started implementing artificial intelligence to help reduce radiology burdens and allow them to take on more cases. However, it appears more hospitals are leaning toward remote work as a preferred solution.
Hospitals like Royal Oak, Mich.-based Corewell Health's William Beaumont Hospital utilizes work from home to keep patient turnaround lower and keep physicians at the system.