Are we prepared for a looming shortage of radiologists?

The rapid and accurate results of an imaging examination can be the difference between life and death. Yet the number of practicing radiologists in the United States is likely insufficient to meet the growing demand. This shortage is also expected to worsen, and according to the Association of American Medical Colleges (AAMC), the United States is expected to have a shortage of 17,000 to 42,000 radiologists, pathologists and psychiatrists by 2033.¹ On average, the number of diagnostic imaging studies increases by up to five percent per year, but the number of X-ray stays increases by only two percent.²

This deficiency has a dramatic impact on patient care. A shortage of radiologists leads to increased treatment times for test results that can be generated, which can have a negative impact on patient outcomes. A recent study showed that delays in x-rays are an independent prediction for the length of hospital stays.³ Another recent study showed that it took more than three hours to generate a report from an average CT study where the radiologist was the bottleneck 42 percent of the time.⁴ This delay in clinically relevant information can have a significant impact on patients. These delays unnecessarily strain healthcare systems, patients and insurance companies and can be addressed through improved image coverage. Although the situation may seem serious, there are many potential solutions.

The first and most immediate solution would be an increase in the number of radiologist stays. The number of positions is largely determined by Medicare, and there have been only marginal increases over the years in radiology. In 2006, there were 1,011 X-ray positions. In 2020, there were 1,113 X-ray stays. However, this slow increase has begun to change as Congress passed an extension of a graduate medical education (GME) in 2020, which added 1,000 new residencies, many of which are likely to be radiology positions.

Increasing medical students’ awareness of the thesis is another promising way to combat the shortage. Medical students often have little exposure to the radiology thesis, and a recent study showed that only 35 percent had completed a radiological rotation by exam.⁵ This could be remedied by promoting radiology as a core rotation in the study of medicine as well as increasing the amount of radiology material covered under the preclinical curriculum. One study found that adding just 2.5 hours of radiology lectures to the first year of medical school significantly increased students’ interest in radiology and increased the likelihood that students would complete a radiology rotation later in the curriculum.⁶ This is a promising solution, as more medical students who are interested in and match with radiology can potentially reduce the impact of the radiologist shortage.

Another solution to this workforce challenge is to achieve improvements in radiology efficiency. Many studies have examined potential methods by which radiologists can increase efficiency. Promising solutions include diminishing distraction and integrating the use of artificial intelligence (AI) into practice.^7.8 Interruptions due to phone calls, emails and consent forms can hinder a radiologist’s workflow, which could potentially lead to reduced performance and less informed consultations.⁸

Reducing these distractions through the use of reading room coordinators and improved communication workflows are often sought as solutions to improve efficiency. In addition, AI enables radiologists to perform their roles with greater efficiency. Although unlikely to replace the role of the radiologist, AI can be used to help measure lesions, compare examinations, and triaging scans that have an increased risk of being urgent. One study found that AI could be used to select which X-rays of the thorax were more likely to be abnormal, and then prioritized them for interpretation by radiologists.⁷ This method was able to reduce the mean delay in the interpretation of abnormal scans from 11.2 days to 2.7 days.

Finally

Although current trends in the number of practicing radiologists may seem worrying, the future is bright. There are many effective solutions to this problem, all of which are pursued simultaneously. Many medical schools are integrating more X-ray material into the curriculum, radiology stays are being expanded, and radiologists are becoming more efficient each year. These trends are promising for the future of the field, and with adequate action, the deficiency can be remedied and possibly reversed.

References

1. Dall T, Reynolds D, Chakabarti R, et al. The Complexity of Medical Supply and Demand: Projections from 2018 to 2033. Washington, DC Association of American Medical Colleges. Available at: https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf. Published June 2020. Opened 20 January 2022.

2. Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in the Use of Medical Imaging in U.S. Health Systems and in Ontario, Canada, 2000-2016. JAMA. 2019; 322 (9): 843-856.

3. Courane S, Conway R, Creagh D, et al. Radiological imaging delays as independent predictors of the length of hospital stays in acute medical admissions. Clin Radiol. 2016; 71 (9): 912-8.

4. Perotte R, Lewin G, Tambe U, et al. Improving the emergency department flow: Reducing treatment time for new CT scans. AMIA Annu Symp Proc. December 5, 2018; 2018: 897-906. eCollection 2018.

5. Prezzia C, Vorona G, Greenspan R, et al. Fourth year medical students’ statements and basic knowledge in the field of radiology. Acad Radiol. 2013; 20 (3): 272-83.

6. Branstetter B, Humphrey A, Schumann J. The long-term impact of preclinical education on medical students’ opinions on radiology. Acad Radiol. 2008; 15 (10): 1331-9.

7. Dargan R. Artificial intelligence increases the efficiency and quality of radiology practice. Radiological Society of North America (RSNA). Available at: https://www.rsna.org/news/2019/march/artificial-intelligence-boosts-efficiency. Published March 18, 2019. Opened January 20, 2022.

8. Lee MH, Schemmel AJ, Pooler BD. Radiologist Workflow Dynamics: How Workflow Patterns Affect Radiologists’ Perceptions of Workplace Satisfaction. Acad Radiol. 2017; 24 (4): 483-487.