Radiologist Shortage

[bat21]

This past week at the RSNA meeting, there was a symposium on the current shortage of radiologists. Among the panelists were representatives from the ACR, ABR and ABMS. Each in turn expressed frustration with the situation and described what have been tried and what they thought should be done. The following is a brief summary:

ACR representative: There is/will be a continuing shortage of radiologists by 5%. A recent review showed 44 openings in neuroradiology with only 4 candidates. Radiology leads the shortage among all specialties, followed by Orthopedics. A reason for the shortage is the yearly growth in number of radiologists by 1.5%, with a yearly increase in the number of procedures performed by 4.5%. Total number of procedures performed per year will rise to 450 millions. The procedures are also increasingly more complex and radiologists must now be available 24/7.

RRC (Radiology Review Committee) and ABR representatives: Academia is particularly hard hit. Attendings are overworked and underpaid. There are 600 vacancies, with an average of 5 per residency program. Fellowships are going unfilled. And there is no light at the end of the tunnel because programs are not producing more radiologists. In 1995, the number of residents in training was 4,181 (all levels). The most recent tally is 3,769. Last year, there were only 872 candidates for the oral board. The number of candidates for the CAQs has also decreased. The RRC has approved an increase of 172 slots spread over the next three years. However, two programs are losing accreditation, with a loss of 16 positions. One third of applicants last year failed to match into Radiology.

ACR and ABMS (American Board of Medical Specialties) representatives: Labor estimates can be wrong. In 1990, a shortage of 5,000 radiologists was predicted. 1n 1996, it was thought that there would be a glut. Now in 2002, too few radiologists.
By 2020, there will be a shortage of 200,000 physicians, particularly specialists and a need for 40 new medical schools.

WHAT OPTIONS HAVE BEEN CONSIDERED AND TRIED?

1. The RRC has relaxed and watered down rules goverrning residency programs.
a) In the past, programs must have 1:1 ratio of attending FACULTY to trainee. The wordings have been changed to FACULTY EQUIVALENT. This is sham because PhDs and physicists can now be counted.
b) In the past, fellows must have been trained in ACGME-approved or Canadian residency programs. Now, training considered adequate by program directors is sufficient. This is an attempt to bring in foreign graduates with disparate training and who will never have to/ or can become board certified. These fellows can then stay on to teach and work.

2. Increase the number of trainees in the pipeline - this was not seriously considered and only about 50 additional positions per year were approved. Residency programs do have room to grow. Under RRC rules, programs must do at least 7,000 procedures per year per trainee. On average, they are doing 12,000 now. One stumbling block is funding. Attempts will be made to solicit federal support. Alternative sources are also being considered, such as having private practice groups pay the salaries of residents they intend to hire. This practice does not violate any rule. In fact, the military has sponsored residents in civilian programs for years.

3. Shorten the training period to three years - this was immediately thrown out because four years is barely adequate.

4. Fast tract other specialists - this may soon become a reality, despite vociferous opposition. A most likely scenario is allowing pediatricians to practice pediatric radiology following a short training period. The opposition cites that radiologists in practice can't just do Peds and maybe called upon to read other studies. But Pediatric radiology is in a critical crunch.

5. Develop Radiologist Extenders who, like PAs and CRNAs, can practice under supervision.

6. Consider limitting the scope of the specialty - like letting the orthopods read their things (cardiologists have already taken echo and nuclear cardiology, OBGyns have siphoned off Sono). This is considered a bad idea.

WHAT OTHER FACTORS MAY AFFECT/ALLEVIATE THE SHORTAGE?

1. Managed care.

2. PACS and technical advancements making radiologists more efficient. But these may well lead to more procedures being performed.

3. Self referral pattern?

WHY IS THE SHORTAGE CRITICAL FOR RADIOLOGY?

1. Training programs suffer for lack of faculty. Fellowships may have to be scrapped. Last year there were only 22 CAQs awarded in Peds, 122 in Neuro, 135 in IR and 8 in NM.

2. Will lose TURF battles with other specialties.

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[xraydoc]

Thanks for that excellent update!

This certaintly is a BIG problem that nobody quite knows how to deal with.

Fortunately it is impossible to accurately predict the future! Like we have seen in the past radiology predictions. So there is still hope.

I certainly wonder how long these large salaries can last. Makes one kind of antsy here in the academic world!

 

[Ctrhu]

XRay doc,
By antsy do you mean joining the private sector now while the salaries are high?
I make about three times what my teachers make at the university program. But amny academicians are not suited for private practice. They have so specialized themselves and are no longer generalists. Some have become so dependent on residents and fellows that they are not efficient and can't function on their own.

 

[xraydoc]

Depends on what academic practice you come from. Many (not all) of my colleagues can read circles (accuracy combined with efficiency) around our private practice counterparts across the street. Which we frequently do when we share rotations with them.

As academic radiologists here we do very well, making about 50 percentile compared with private practice. Not counting 3 weeks of conferance anywhere in the world paid for by the university and 12-15 weeks of vacation, as well as paying for nothing else and having no call.

I do wonder what it would be like in private practice, since in my 2 years out I have been here.

I think many of these conversations underscore the difference of the two mindsets. My colleagues in the private practice world always brag how much money they make and how fast they can read. Although me and my partners seem much happier and have more time and money than we know what to do with.

What I have NEVER heard them say when in conversation about the two worlds is how well they take care of the patient and how they enjoy radiology, which we in academia talk about all the time! There is an arrogant attitude on both sides that I have seen since I work with both. Too bad we can't get along and realize that we need each other.

It always disturbs me when I have looked into private practice jobs that the only thing they ask is "can you read fast"?

 

[hedging]

bump

 

[jdog]

I think you guys created your own problem by cutting residency slots a few years ago. It does not take a genious to see that the less people in a field means more demand, more work for each person, less competition for jobs equals more money for radiologists. You created your own problem. You can fix it by opening up more slots. I guarentee you that the people who pull the strings in Radiology will not let this happen. Just about every field in medicine has a shortage of people. There has not been an increase in the number of medical students in this country in almost 15 years while the population has exploded, so clearly there will be a shortage.

Dermatology is the king of creating their own shortage. There are only 250 spots a year. I guess that is why it takes 6 months to get a derm appointment. To alleviate the problem there should be more derms, but that would mean less cash per doctor, and it will be a cold day in hell before they let that happen, so lets not kid ourselves.

 

[Teufelhunden]

Originally posted by jdog
Just about every field in medicine has a shortage of people. There has not been an increase in the number of medical students in this country in almost 15 years while the population has exploded, so clearly there will be a shortage.

Kinda off-subject, but...if the # of U.S. med school grads per year has not increased in 15 years, does that mean that the ratio of docs/patients has been falling? Or have IMGs been compensating, i.e. have we been allowing more IMGs into the U.S.? Also, any idea what % IMGs constitute in the U.S. physician population?

Just curious if you had any insight on that.

 

[jdog]

First, let me say that there might have been a slight increse in number of us med students, but only very slight, not anywhere close to the population explosion.

There are roughly 16,000 american med student seniors each year.

There are roughly 23 to 25,000 residency spots each year. If I am not mistaken, 40% of internal med residents are IMG.

There was an episode in 60 minutes on CBS about a year ago addressing this subject. Basically saying why the hell are we having a third of our residents not grads of us med schools.

I am not sure if there are plans to increase the number of us med students anytime soon. I think FSU either just opened or is opening a med school and Cleve Clinic is opening one. but even so, this will not make a dent.

I don't know about you, but I know people that I went to college with who were very smare, 30 plus MCAT etc who did not get in the first or second time because of stiff competition, then I get to med school and see FMG man of which literally can bearly speak English. There are tons of brilliant IMG out there, but there are also plenty of horrible ones, and I don't see why we can't increase American med student enrollments.

 

[Hornet871]

Sorry, jdog, but you made the temptation irresistible. You describe your US college friends as being "very smare" and then you criticize FMGs for "bearly speak[ing] English". You see what's wrong with this picture, don't you?

 

[MacGyver]

jdog,

one thing you forgot is DO schools. There have been a number of new DO schools opened in the last 10 years

Besides, the US already has one of hte highest numbers of docs per capita in the world.

 

[volvulus]

MacGyver, I love the quote you include at the bottom of your posts.

 

[Dawg_MD]

Again off subject, but I thought I would point something out regarding the post about FMG's of which I am one. I made a 32 on the MCAT and had an above average GPA. I went through the process several times but unfortunately I am in the category that gets discriminated against most by the application process : white, male, heterosexual from a middle class family. Thus, I was only able to get so far as being wait-listed. Rather than get upset at the system, I took matters into my own hands and went to SGU in Grenada. I am sure that many of the FMG's that you refer to coming into our country were actually US citizens who for one reason or another did not get into a US school.
I won't try to pretend that everyone in my class should be going into Medicine, but the same could be said for ANY medical school class at a US institution.

 

[me109cito]

Originally posted by Dawg_MD
Again off subject, but I thought I would point something out regarding the post about FMG's of which I am one. I made a 32 on the MCAT and had an above average GPA. I went through the process several times but unfortunately I am in the category that gets discriminated against most by the application process : white, male, heterosexual from a middle class family. Thus, I was only able to get so far as being wait-listed. Rather than get upset at the system, I took matters into my own hands and went to SGU in Grenada. I am sure that many of the FMG's that you refer to coming into our country were actually US citizens who for one reason or another did not get into a US school.
I won't try to pretend that everyone in my class should be going into Medicine, but the same could be said for ANY medical school class at a US institution.

Your post implies that you were descriminated against because you are white, male, heterosexual and from a middle class background. Surprisingly most of my classmates fit your same profile.

 

[Dawg_MD]

That is exactly what I am saying. The reason that most of your class fits that profile is because the majority of applicants fit that profile. However, if you were to look at the scores and GPA of students at ANY medical school, I would guarantee you that the averages for those in the minority are significantly lower. Do you disagree that if you do not fit into at least one type of "minority" group, then you are held to a different standard than those who are minorities when it comes to the application process?

Just pointing out the obvious....

 

[NaeBlis]

and the averge grades and MCATS of asian students are higher than the average at any medical school. Whites are discriminated against but not as much as asians. And once you are the the system white people have all the advantages. Clinical grades are largely "social evaluations".