How Much Do Radiologists and Radiation Oncologists Specialize?

Trends in Authorship Patterns in High-Impact Radiology Publications, 1980-2013

RATIONALE AND OBJECTIVES

Concerns have been raised about authorship inflation in medical literature. The purpose of this study was to determine how the number of authors per radiology article has changed over time with regard to study type and geographic factors.

MATERIALS AND METHODS

We collected data on study type, authorship count, and the country of the corresponding author for a sample of articles published in Radiology, American Journal of Roentgenology, and European Radiology in 1980, 1990, 2000, and 2013. Only original research and review articles were considered. We computed trends in the mean number of authors per article for each journal and compared authorship trends between study types and geographic region. The study did not involve human subjects and was therefore exempt from institutional board review at our institution.

RESULTS

A total of 682 articles were reviewed, of which 572 were original research articles (83.9%) and 110 review articles (16.1%). The overall number of authors per article doubled from 3.6 in 1980 to 7.3 in 2013 (P < .001). From 1990 to 2013, the largest absolute increase in authorship count was in Radiology (4.4-8.1, 84.1%, P < .001). The largest increase in authorship occurred in original research articles (3.7-7.8, 111%, P < .001). Although authorship counts were greatest in Asia over most study period, growth in authorship count was highest in Europe.

CONCLUSIONS

Authorship count has dramatically increased in radiology journals in the last 3 decades, particularly in original research articles and in Europe.

Subspecialization in radiology and radiation oncology

Practicing radiologists, radiation oncologists, and trainees were surveyed regarding the current state of subspecialization in practice and in training curricula. The authors present the results of these surveys, establish trends compared with previous survey data, and compare the plans of trainees with current postgraduate practice. Subspecialization is increasing in both radiology and radiation oncology. There remain substantial numbers of practitioners who perform work they deem "general" in nature. The authors also present a method to more accurately measure subspecialization and workload.

Diagnostic radiologists' subspecialization and the new final board examination

OBJECTIVE

Recognizing that subspecialization can consist of concentration in multiple fields as well as in a single main field, we conducted this study to profile in detail the subspecialization of diagnostic radiologists in the United States in ways that illuminate issues related to the American Board of Radiology plan for a new final examination.

MATERIALS AND METHODS

We tabulated nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a stratified random-sample mail survey with 1,924 responses and a 63% response rate. Respondents were guaranteed confidentiality. Responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Sixty-nine percent of respondents reported specializing at least to a small extent. If concentration in a field is defined as spending 10% or more of clinical work time in the field, 51% of radiologists concentrated in one or two fields, 24% in three or four fields, and 21% in more than four fields. An examination covering a radiologist's four most time-intensive fields would cover 80% of the clinical work of the median radiologist. However, the one fourth of radiologists whose work is most varied would have 40% or more not covered by the examination, but the one fourth with the most concentrated work would have 100% covered.

CONCLUSION

Most radiologists concentrate in a few fields, making the American Board of Radiology plan for an examination that covers four fields--or fewer, at an examinee's discretion--a major step forward in recognizing the nature of current practice. Four fields, however, are too many for the practice patterns of many radiologists but too few for the practice patterns of a substantial minority. We offer for consideration more far-reaching reforms.

Radiologists' clinical practice of neuroimaging

PURPOSE

Because of the importance of neuroimaging as a radiology subspecialty, the aim of this study was to provide a detailed portrait of the demographics, clinical activities, and practices of radiologists heavily involved in neuroimaging.

METHODS

The authors analyzed data from the ACR's 2003 Survey of Radiologists, a large, stratified random-sample survey in which respondents were guaranteed confidentiality. The survey achieved a 63% response rate, and responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Three-fourths of US radiologists reported doing neuroradiology; 9% reported that neuroradiology was their main subspecialty, and 9% reported spending more than 50% of their clinical work time doing neuroradiology. Of these latter two categories, more than about 75% had certificates of added qualification (CAQs) in neuroradiology, and more than 80% had done neuroradiology fellowships. However, of those spending more than 50% of their clinical work time doing neuroradiology, 7% neither had CAQs nor had done fellowships in the field. One-fourth of radiologists with CAQs or who had done neuroradiology fellowships spent less than 30% of their clinical work time doing neuroradiology. One-third to one-half of neuroimaging was performed by radiologists not heavily involved in the field. Only 6% to 8% of radiologists heavily involved in the field were women, compared with 22% in other subspecialties.

CONCLUSIONS

Neuroimaging has the great strength of being a relatively well-integrated subspecialty in that a very large majority of those heavily involved in its practice have CAQs and did fellowships in the field. Among possible concerns are the relatively few women in the field and the apparent waste of expertise resulting from one-fourth of those with neuroradiology subspecialty training or certification being relatively little immersed in its practice.

Radiation Oncologists in the United States

PURPOSE

To provide an extensive and detailed portrait of radiation oncologists, their professional activities, and the practices in which they work.

METHODS AND MATERIALS

We analyzed non-individually identified data from the American College of Radiology's 2003 Survey of Radiation Oncologists, a stratified random sample survey that guaranteed respondents' confidentiality and achieved a 68% response rate, with a total of 472 responses. Responses were weighted to make them representative of all radiation oncologists in the United States. We use two-tailed z tests of percentages and means to compare information from the current survey with those from a similar 1995 survey.

RESULTS

The number of posttraining, professionally active radiation oncologists grew from nearly 2900 in 1995 to nearly 3500 in 2003, an increase of approximately 21%. Twenty-three percent of posttraining, professionally active radiation oncologists were women. Among posttraining, professionally active radiation oncologists, 95% were board-certified. Forty-eight percent of radiation oncologists were in nonacademic, radiation-oncology-only private practices; 20% in academic practice; 14% in nonacademic, multispecialty practices; and 11% in solo practice. The largest percentage of radiation oncologists worked in the South (34%). The average annual number of patients treated (curative and palliative) per radiation oncologist was 264. On average, radiation oncologists preferred a 4% increase in their workload. The proportion of radiation oncologists planning a career change decreased from 8% in 1995 to 4% in 2003, and in 2003 34% said they were enjoying radiation oncology more than 5 years earlier, compared with 21% in 1995.

CONCLUSION

Despite concerns in 2003 about lower-than-optimal workload, professional satisfaction, if anything, increased since 1995.