Diagnostic radiologists in 2000: basic characteristics, practices, and issues related to the radiologist shortage

Level of Awareness Regarding Interventional Radiology Among Medical Students at Northern Border University in Arar, Saudi Arabia

Introduction Interventional radiology (IR) is a highly specialized field of radiology that employs advanced imaging techniques like MRIs, CT scans, X-rays, and ultrasounds to detect and treat a variety of medical disorders. By using minimally invasive procedures, interventional radiologists can access the body's internal organs and tissues with minimal discomfort and reduced risks compared to traditional surgical techniques. Some common IR procedures include angioplasty, embolization, biopsy, and stent placement, among others. Overall, IR is an innovative and effective approach to medical care that offers numerous benefits to patients. As this specialty expands, there is a huge demand for increasing staff. However, due to a lack of awareness, this increased demand could not be fulfilled. Objective The objective is to assess medical students' knowledge regarding IR and compare this knowledge between male and female students. Materials and methods This cross-sectional study was carried out at Northern Border University's College of Medicine in Arar, Saudi Arabia. The study aimed to assess the medical students' knowledge of IR. All students enrolled in the clinical years at Northern Border University were included in the study, and a self-administered online questionnaire was used to collect data. The minimum sample size required was 169. Appropriate statistical analysis was applied to the collected data, and a p-value of less than 0.05 was considered significant. Results One hundred and seventy-two participants in all who met the inclusion criteria answered the study's questionnaire. The fourth-year students represented the highest percentage of the sample, with 65 participants (37.8%), followed by 54 (31.4%) fifth-year students and 53 (30.8%) sixth-year students. The study found that 66 participants (38.4%) rated their knowledge of IR as adequate, while only 8 (4.7%) considered it excellent. The participants' self-rated knowledge of IR did not significantly differ across male and female groups. Conclusion The study's findings suggest that medical students have limited knowledge of IR and that there is no discernible difference in the knowledge and interest of males and females in this subject. Further research and targeted educational interventions may be necessary to improve the medical students' overall knowledge and interest in IR.

Awareness of Interventional Radiology Among Medical Students at Majmaah University, Saudi Arabia

INTRODUCTION

Interventional radiology (IR) is a medical specialty that employs imaging techniques such as X-rays, ultrasound, CT scans, and MRI to guide minimally invasive procedures for diagnosing and treating a variety of medical disorders. The purpose of this investigation was to determine the level of IR awareness among medical students at Majmaah University.

METHODS

The cross-sectional investigation was carried out among the medical students at Majmaah University in Saudi Arabia. A self-administered questionnaire that had been pretested was used to gather the data. SPSS Statistics (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp) was used to analyze the data. The chi-square test was used to compare qualitative data, and a p-value <0.05 was considered significant.

RESULTS

There were 202 students who participated in this study, and among them, the majority were males, 126 (62.4%), and the majority of them were pre-clinical students, 105 (52.0%). Knowledge of routinely performed procedures by IR (only by a radiologist) was assessed; 116 (57.4%) of them responded with paracontinuous transluminal coronary angioplasty, 105 (52.0%) with central venous access, and 100 (49.5%) with lower arterial limp percutaneous transluminal angioplasty, which are routinely performed procedures by the radiologists. There was no significant difference in knowledge levels between genders.

CONCLUSION

Increasing awareness of IR among medical students is essential to improving patient outcomes and addressing healthcare challenges. Efforts to educate and expand access to IR services must be prioritized to ensure that medical students receive a comprehensive education and that patients receive the highest quality care possible.

Worldwide Knowledge About Interventional Radiology Among Medical Students: Findings of a Comprehensive Review

PURPOSE

The objective of this comprehensive review is to investigate the studies assessing the interventional radiology knowledge among medical students worldwide and inspect the feasible solutions for improving their perspective on this specialty.

METHODS

A comprehensive literature search was accomplished on PubMed, Scopus, Web of science, and Embase databases. The quality of eligible articles was assessed with the QATSDD assessment tool.

RESULTS

After screening of articles, 29 studies were included. All the included articles were published between 2009 and 2021, with 20 studies performed in 2017 and thereafter. Interventional radiologists' duties, procedures, and training pathways were the main subjects investigated in surveys. The interest and exposure to interventional radiology were also assessed. All the studies indicated that the knowledge about interventional radiology compared with other specialties is weak. In 14 studies, over 50% of participants reported their interventional radiology knowledge as either poor or none. The most reason for not considering interventional radiology residency was lack of awareness during medical schools. Studies which held a tutorial course reported the students' awareness and interest improved significantly after the course.

CONCLUSION

The present evidence indicates that although the current awareness of interventional radiology is low, timely didactic courses in medical schools can improve this condition significantly, lead to graduation of more oriented referring physicians, and also attract more fit applicants to interventional radiology residency programs.

Accuracy of emergency physician bedside ultrasonography compared with private teleradiologist for acute appendicitis diagnosis

BACKGROUND

Acute appendicitis (AA) is a common cause of abdominal pain resulting in admission to the emergency room. Imaging methods such as ultrasonography and CT are usually used for diagnosing acute appendicitis. Reports regarding CT scans conducted during night shifts are prepared by private teleradiologists.

AIMS

The aim of this study was to compare the accuracy of point-of-care ultrasound performed by an emergency medicine specialist and private teleradiologists in the diagnosis of AA.

METHODS

This study was conducted prospectively and in a single center in the emergency department of a tertiary hospital. Patients who were admitted to the study between 15.09.2020 and 15.09.2021 and were diagnosed with AA who met the study criteria were included. A total of 134 patients diagnosed with AA, who met the inclusion criteria, out of 158 operated patients were included in the study.

RESULTS

In the study, 77 were male and 57 were female. The mean age of patients with histopathologically positive AA was 31 and 31.5 in negative patients. The sensitivity and specificity of POCUS performed by the emergency physician and private teleradiology for the diagnosis of AA were 78.4% and 59.3% and 58.8% and 53.1%, respectively.

CONCLUSIONS

POCUS performed by an emergency medicine specialist showed a higher sensitivity for the diagnosis of AA compared with private teleradiology. Hence, POCUS is more successful in diagnosing AA than private teleradiology. In conclusion, we recommend the concurrent use of AS and POCUS in emergency departments rather than private teleradiology for the diagnosis of AA.

The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study

Background

Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated.

Objective

This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students.

Methods

This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cramér’s V test.

Results

In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001).

Conclusions

No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students’ judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception.

Awareness of Interventional Radiology Among Medical Students at a Saudi Medical School: Clerkship versus Pre-clerkship Years

Objectives

We sought to assess the awareness of interventional radiology (IR) as a specialty among medical students and determine any difference between the clerkship and pre-clerkship years.

Methods

We conducted a cross-sectional, survey-based study in February 2018 at King Abdulaziz University, Jeddah, Saudi Arabia. Five hundred and forty-two medical students were enrolled. The survey consisted of 17 items canvassing student awareness of and interest in IR. The data were compared using the chi-square test.

Results

A large proportion of the respondents (n = 199, 36.7%) rated their knowledge of IR as poor, and 85 (15.7%) reported that they knew nothing about IR. Only 87 students (16.1%) responded that they would consider a career in radiology. The most common reason for not considering IR was lack of knowledge (42.9%). Students in their clerkship years had more interest and exposure to IR than pre-clerkship students (73.0%, p < 0.001 and 55.7%, p = 0.030, respectively). Awareness of IR was significantly more common among those interested in diagnostic radiology and IR (65.5%, p < 0.001 and 61.5%, p = 0.010, respectively).

Conclusions

Awareness of and exposure to IR is poor among medical students, and can only be increased by a direct contribution from IR physicians to the undergraduate curriculum. Lack of a unified radiology curriculum in medical schools across the country should be addressed by the Council of Deans of Saudi Medical Schools. Involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

The advantages, disadvantages, and policies for part-time radiologists: report of the ACR Commission on Human Resources

The employment of part-time radiologists (PTRs) has both advantages and disadvantages in various practice settings. The authors examine the pros and cons of PTRs and review the literature regarding PTRs both within and outside the specialty of radiology. The complexity of this issue is manifested in our inability to reach consensus on many policy issues for PTRs. Nevertheless, this article should be helpful in offering an objective, nonbiased background to initiating a discussion on employing PTRs in various radiology practices.

Exposure to, understanding of, and interest in interventional radiology in American medical students

RATIONALE AND OBJECTIVES

The purposes of this study were to determine the degree to which medical students are exposed to interventional radiology (IR) in medical school, to assess their knowledge of the field, and to gauge their interest in IR as a career choice.

MATERIALS AND METHODS

An institutional review board-approved survey was generated using the website www.surveymonkey.com. Medical student participation nationwide was elicited by sending e-mails to administrators of medical schools and radiology residency program directors and asking them to distribute the survey link to their students.

RESULTS

Seven hundred twenty-nine medical students from 21 states responded to the survey. Although 58% of students said they were interested in a hands-on career, only 5.5% of students said they had participated in an IR rotation and only 12.7% were interested in IR. Less than half of the IR domain-related questions used to assess understanding of IR were answered correctly, with greater understanding found among the students who had participated in an IR rotation.

CONCLUSIONS

Exposure to IR in accredited US medical education programs is inconsistent, although interest in the field is moderate among medical students compared with interest in other hands-on specialties. Understanding of IR is limited among the study population. Improved understanding of the field and recruitment could result from greater exposure.

Awareness and level of knowledge of interventional radiology among medical students at a Canadian institution

PURPOSE

To assess the awareness and level of exposure of interventional radiology (IR) among medical students at a Canadian medical school. To understand how IR can be better described and introduced to medical students.

MATERIALS AND METHODS

Electronic anonymous surveys were sent to 542 medical students in their first, second, and third years at a Canadian 3-year medical school. A total of 103 students (19%) responded. Each survey contained 17 questions assessing knowledge, interest, and perception of IR.

RESULTS

Fifty-three percent (55/103) of respondents reported "poor" knowledge of IR and only 18% (19/103) said they would consider a career in IR. Respondents cited lack of knowledge (48%, 37/77) or lack of interest (43%, 33/77) as the main reasons why they would not consider IR as a career. Although 92% (95/103) of respondents could name at least one IR procedure, many (54%, 56/103) were unclear as to the duties of an interventional radiologist within the hospital. Seventy-four percent (76/103) of students stated that a mandatory 2-week rotation in radiology during clerkship would be beneficial, whereas 71% (73/103) stated that they would be interested in a 2-week IR selective during their mandatory core surgery rotation.

CONCLUSIONS

The knowledge and exposure to IR in medical school is limited. Students were eager to learn more about IR and expressed a desire for more exposure. Early exposure of medical students to IR should be introduced to attract future interventional radiologists as well as increase awareness among future referring physicians.

A survey of interventional radiology awareness among final-year medical students in a European country

Interventional radiology (IR) is a rapidly expanding specialty that is facing the challenges of turf wars and personnel shortages. Appropriate exposure of medical students to this field can be vital to recruitment of potential future trainees or referring physicians. The aim of this study was to determine the knowledge and views of final-year medical students in a single EU country regarding various aspects of IR. An electronic survey was sent via e-mail to all final-year medical students in a European country. The students were given a month to respond to the questionnaire. A total of 234 students of 675 (34.5%) replied to the survey. Of the respondents, 35% had previously completed an attachment to the radiology department. The majority of students (63%) thought their knowledge in radiology in general was poor. The percentage of students who correctly identified procedures performed by interventional radiologists was 69% for Hickman line insertion, 79% for fibroid embolization, and 67.5% for lower limb angioplasty. Sixty percent, 30%, and 47% thought that interventional radiologists perform cardiac angioplasties, perform arterial bypasses, and create AV fistulas, respectively. Forty-nine percent felt that interventional radiologists are surgically trained. Eighty-three percent of students were first made aware of angioplasty by a cardiologist. Thirty-one percent thought that interventional radiologists do ward rounds, 24% thought that interventional radiologists have admitting rights, and 26% felt that interventional radiologists run an outpatient practice. A significant number of students (76%) thought that the job prospects in IR are good or excellent but only 40.5% were willing to consider a career in IR. In conclusion, this study indicates that IR remains a nascent but attractive specialty to the majority of medical students. Further development of the existing informal undergraduate curriculum to address shortcomings will ensure that IR continues to attract the brightest talents to the field.

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.

The growing size of radiology practices

PURPOSE

To describe trends in the size of radiology practices from 1990 to 2007.

METHODS

Data from the American College of Radiology's 1990, 1995, 2000, and 2003 surveys of radiologists and radiation oncologists and its 2007 survey of radiologist members are compiled to describe the changing distribution of radiologists by practice size over time. All estimates are weighted to be representative of all radiologists in the United States.

RESULTS

The fraction of radiologists in small practices (1-4 radiologists) decreased from 29% in 1990 to 22% in 2007. The fraction in medium-sized practices (5-14 radiologists) decreased from 51% in 1990 to 38% in 2007. The fraction in practices with 15 to 29 radiologists increased from 14% in 1990 to 21% in 1995 and has since remained constant. The fraction in practices with 30 or more radiologists grew from 5% in 1990 to 19% in 2007, but since 2000, growth among these practices has largely been limited to practices with 60 or more radiologists. The median radiologist was in a 7-radiologist practice in 1990. This size increased to 11 in 2000 and was the same in 2007. The size of a practice at the 90th percentile of radiologists increased from 22 in 1990 to 45 in 2007.

CONCLUSION

Radiology practices grew in size throughout the 1990 to 2007 period. In general, changes were more rapid in 1990 to 2000 than since. The most conspicuous growth was in practices with 30 radiologists or more. This category almost quadrupled its share of radiologists. In contrast, the share of very small practices (1-4 radiologists) declined relatively little, by only approximately one-fourth.

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.

Outsourced teleradiology imaging services: an analysis of discordant interpretation in 124,870 cases

PURPOSE

Outsourcing after-hours radiology coverage to a teleradiology coverage company has become common in recent years. However, concerns have been raised over the quality of these types of coverage and the implications on patient care. This study details the quality assurance program of a teleradiology company that provides after-hours coverage to 64 California hospitals.

METHOD

The records of all examinations interpreted by 10 radiologists during 2003 were reviewed. Interpretations were compared with the final interpretations of the host practices and evaluated for timeliness.

RESULTS

A total of 124,870 radiologic studies were interpreted by 10 teleradiologists during 2003. Computed tomography (CT) comprised 74% of these examinations: CT head (35%) examinations were the most commonly transmitted examinations, and CT abdomen/pelvis examinations were the second most common studies (27%). The average turnaround time was 12.2 min; 93% of the examinations were reported within 30 min, and 99% were completed within 1 hour. The overall discordant rate for individual teleradiologists ranged from 0.70% to 1.41%, with an average of 1.09%. Of the most commonly ordered examinations, CT of the abdomen/pelvis had the highest rate of discordance, at 2.1%.

CONCLUSIONS

Outsourcing to a teleradiology program with an active quality-assurance program can be safe. An active quality-assurance program should be an integral component of any teleradiology program. Constant feedback improves the performance of the radiologists.

Comparison of productivity and cost of full-time and part-time faculty members in an academic department of radiology

PURPOSE

To compare financial productivity and employment costs of full-time and part-time faculty members and to assess qualitative factors related to part-time employment.

MATERIALS AND METHODS

Financial productivity and employment costs were compared for full-time and part-time staff members on the basis of a review of financial records from fiscal year 2005. Part-time and full-time faculty members were interviewed to determine reasons for working part-time and to assess the attitudes of both full-time and part-time faculty members toward part-time status.

RESULTS

Part-time radiologists working an average 65% schedule constituted 13% of the total full-time equivalent faculty complement and performed 14% of the clinical work at an average of 0.88 physicians' component total relative value units while more than covering their costs. Part-time radiologists were more productive while interpreting examinations of lesser relative value unit value than full-time radiologists.

CONCLUSION

Part-time radiologists are an important resource for the specialty and should be nurtured to stay in practice.

The future workforce in academic radiology: gender, generational, and cultural influences

The acute shortage of academic radiologists in the United States, and in fact across the world, is a multifactorial issue. A review of the recent literature suggests a number of influences that discourage radiology residents from remaining in academics, including cultural and generational values and their gender roles in our society. This article discusses the influence of gender, generational, and cultural issues on the current and future workforce in academic radiology.

Women as radiologists: are there barriers to entry and advancement?

PURPOSE

In consideration of the fact that women constitute only 25% of radiology residents, even though they constitute 45% of medical students, this study was conducted to determine if the trend of women choosing radiology as a career differs from that for other medical specialties and if there are differences on the basis of the gender of program directors or geographic location. The authors also wished to determine if constraints exist that prevent women from advancing into positions of leadership in radiology.

METHOD

The percentage of women in each of the 186 radiology residency programs was compiled to determine the mean and standard deviation of women represented and from those data to examine if there were patterns of exclusion related to program size, location, or the gender of program directors. The membership and committee lists of the ACR and the Radiological Society of North America (RSNA) were examined to gauge the participation of women as leaders in these 2 organizations, as were the mastheads of Radiology and the American Journal of Roentgenology. The number of female chairs of academic departments was also examined.

RESULTS

Over the past decade, the percentage of women in diagnostic radiology residencies has remained remarkably constant at or slightly above 25%. There was no discernable prejudice against women applicants by program size, location, or program director gender. In both the ACR and the RSNA, women are represented in positions of leadership approximately in proportion to their percentage in the general membership. Journal mastheads have fewer women than might be expected given the participation of women in academic radiology. There are a small but increasing number of women chairing academic radiology departments.

CONCLUSION

The relatively low percentage of women in diagnostic radiology residencies is not a reflection of the gender of program directors. Women are represented in positions of influence and authority in major organizations in American radiology in proportion to the overall number of women in the organization. However, women continue to be underrepresented in radiology chair positions. Explanations must be sought for the relative unattractiveness of radiology to prospective women residents and barriers to the advancement of women in academic radiology.

Choosing a Specialty in Medicine: Female Medical Students and Radiology

OBJECTIVE

The purpose of this study was to determine whether there are identifiable factors that dissuade female medical students from entering the field of radiology.

MATERIALS AND METHODS

An anonymous survey was completed by medical students at the end of their third- or fourth-year radiology clinical clerkships at five institutions. In addition to demographic data and residency choice, respondents ranked 10 factors in order of importance to their choice of career. For respondents who did not consider radiology a possible career, a second set of eight factors was ranked for importance in dissuading them.

RESULTS

Two hundred eighty-eight respondents completed the survey, 152 (53%) men and 136 (47%) women. Both men and women reported direct patient contact and intellectual stimulation as the most important factors in deciding on a specialty. For those who chose radiology, intellectual stimulation and use of emerging technology were significantly (p < 0.05) more important than other factors. The factor that most strongly (96%) dissuaded men and women from a career in radiology was lack of direct patient contact. There was no significant difference between men and women in ranking factors that dissuaded them from applying to radiology residencies; however, nearly one third of the female respondents cited competitiveness of the residency process as important.

CONCLUSION

Patient contact remains an important factor for medical students choosing a career. To attract high-caliber students, medical schools should expose students to areas of radiology involving patient interaction. Academically qualified women should be identified early during their careers and encouraged to apply for radiology residencies.

Indian Radiologists in the United States: Hierarchical Distribution and Representation

PURPOSE

To evaluate both the distribution of radiologists of Indian ancestry and nativity in the United States in training and beyond and their representation in hierarchal positions in major radiology organizations.

MATERIALS AND METHODS

The annual membership lists of the Radiological Society of North America (RSNA) and the ACR over the past decade were analyzed for the number and locations of radiologists of Indian ancestry or nativity. To evaluate the progression and current extent of enrollment of members of this cohort in positions of leadership in radiology organizations, their overall membership and their specific participation in RSNA and ACR committees were tabulated. Their listing in the latest directories of chairpersons and program directors in radiology was assessed. The distribution of ethnic Indian radiologists in training was calculated by examining resident rosters by academic program and state.

RESULTS

Since the passage of the Immigration and Nationality Act of 1965, individuals of Indian ancestry have constituted a growing minority of radiologists. In 2002, they constituted 5.5% of all RSNA members. Recently, their numbers in training programs have increased greatly. They are now estimated to constitute 13.3% of all residents, predominantly because of the entry of the American-born offspring of Indian immigrants. Yet ethnic Indians are markedly underrepresented in the hierarchy of major radiology organizations. In both 1999 and 2003, there were no Indian-surnamed representatives on most major committees and none in board-level positions of both the ACR and the RSNA. The number of radiologists of Indian birth or background who are program directors has increased slightly over the past 10 years from 2:196 (1%) in 1993 to 7:196 (3.5%) in 2003. The representation of radiologists of Indian ethnicity on the mastheads of both the American Journal of Roentgenology and Radiology remains meager; fewer than 2% of these journals' assistant editors and editors are of Indian ethnicity.

CONCLUSION

The percentage of radiologists identifiable as Indian by nativity or ethnicity is growing rapidly, predominantly because of an increase in the number of American-born trainees. Yet only a few more senior members of this group have secured positions of leadership in the specialty, restricting the number of ethnically similar role models for Indian junior members of the specialty to emulate.

Women Radiologists in the United States: Results from the American College of Radiology's 2003 Survey

PURPOSE

To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists.

RESULTS

Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men.

CONCLUSION

Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.

The state of teleradiology in 2003 and changes since 1999

OBJECTIVE

The purpose of our study is to describe in detail the use of teleradiology in 2003 and to report on changes since 1999 in this rapidly evolving field.

MATERIALS AND METHODS

We analyze non-individually identified data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample mail survey that achieved a response rate of 63%, and data from the American College of Radiology's 1999 Survey of Practices. Responses were weighted to represent the distribution of individual radiologists and radiology practices nationwide. We present descriptive statistics and multivariable regression analysis results on the prevalence and uses of teleradiology in 2003 and comparisons with 1999.

RESULTS

Overall, 67% of all radiology practices in the United States, which included 78% of all U.S. radiologists, reported using teleradiology. A significant increase (p < 0.05) was seen in the prevalence of teleradiology or PACS, from 58% of practices in 1999 to 73% in 2003. Regression results indicate that, other practice characteristics being equal, in 2003, primarily academic practices were less likely to use teleradiology than private radiology practices, and medium-sized practices (5-14 radiologists) were more likely to have teleradiology than larger ones. In practices using teleradiology, home was the most frequent receiving site in both 1999 (81%) and 2003 (75%), the percentages being not significantly different.

CONCLUSION

Already a fixture of radiology practice in 1999, teleradiology increased in prevalence substantially by 2003. The primary use of teleradiology, transmission of images to home, did not change, suggesting that easing the burden of call remains the main use of teleradiology.

Retirement patterns and plans of radiologists

OBJECTIVE

The objectives of our study were to describe radiologists' recent retirement plans and patterns and to assess whether changes in radiologists' retirement patterns over the period of 1995-2003 explain the recent easing of the radiologist shortage.

MATERIALS AND METHODS

We present detailed information from 2003 about the planned retirement age of radiologists, their labor force participation late in their careers, and their actual retirement pattern based on data from the American College of Radiology's (ACR) 2003 Survey of Radiologists. To analyze changes over time, we compare these data with information from the ACR's 1995 and 2000 Surveys of Radiologists. Multivariate regression analysis was also used to identify the effects of radiologist and practice characteristics on radiologists' retirement plans.

RESULTS

The percentage of radiologists fully retired and the average retirement age were the same in 1995 and 2003. Overall, labor force participation rates were decreasing over the period 1995-2003 for both women and men. Standardized labor force participation rates for radiologists age 55-74 years appeared to decrease from 1995 to 2000 and remained at a lower level in 2003, but the changes were not statistically significant. As of 2003, radiologists retired at 64, approximately 2 years older than the average U.S. worker.

CONCLUSION

Radiologists remain active in their profession longer than the typical U.S. worker. There was no change in radiologists' pattern of gradually moving into retirement. If anything, radiologists were retiring earlier in 2003 than in the past. A delay in retirement is not an explanation of the recent easing of the radiologist shortage.

A Portrait of Breast Imaging Specialists and of the Interpretation of Mammography in the United States

OBJECTIVE

Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms.

MATERIALS AND METHODS

We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average.

CONCLUSION

Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

Determinants of Radiologists’ Productivity in Private Group Practices in California

PURPOSE

The purpose of this study was to determine factors that would affect radiologists' productivity in private group practices in California.

METHODS

Individual productivity data were collected for 236 private practice radiologists from 6 private radiology groups in California. The data included information on physician characteristics, facility indicators, and group practice factors that were hypothesized to affect providers' productivity. Statistical tests including chi-square testing and multivariate linear regression were used to analyze the effect of the 3 groupings of factors on the productivity of the radiologists.

RESULTS

With increases in age, the number of years in practice, and the number of years in affiliation with the group practice, productivity seemed to decrease. On the other hand, productivity tended to increase if a radiologist was a shareholder, with an increase in the number of facilities served by the radiologist per day, in the proportion of imaging examinations and interventional procedures conducted, and in the proportion of those examinations stored in picture archiving and communication systems.

CONCLUSIONS

To improve radiologists' productivity, group practices must invest in data-reporting infrastructure for tracking productivity, contract with outpatient imaging centers, and review group practice partnership composition and incentive models to ensure higher productivity. Future studies might consider examining the effect of other factors, such as time spent on nonclinical duties and the use of paramedical assistants in the practice.

A Portrait of Pediatric Radiologists in the United States

OBJECTIVE

In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists.

RESULTS

Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas.

CONCLUSION

A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

Update on the Diagnostic Radiologist Employment Market: Findings Through 2004

OBJECTIVE

The objective of this article is to summarize the latest information concerning the diagnostic radiologist employment market.

MATERIALS AND METHODS

Three sources of data are presented and compared with previous data: vacancies in academic radiology departments as of July; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in Radiology and the American Journal of Roentgenology.

RESULTS

Vacancies in academic radiology departments averaged 3.9 in 2004, down 29%, and decreased for all subspecialties as compared with 2001, but the number of vacancies remained very similar to that for 2003. Job listings per job seeker were 1.1 in 2004, stable over the past 2 years but at the lowest level since 1997. The overall number of positions advertised declined by 14% in 2003 compared with 2002 and by an additional 17% in 2004, reaching the lowest level since 1998. In 2004, 45.3% of positions advertised were academic. Comparing 2003-2004 with 2001-2002, all geographic regions exhibited absolute declines in advertisements except the Northeast, which showed a 1.5% increase. Absolute increases occurred for musculoskeletal and emergency radiology positions. Statistically significant proportional decreases occurred for general radiology, vascular/interventional radiology, and pediatric radiology.

CONCLUSION

Three separate data sources confirm a substantial and broad-based multiyear decline in the strength of the demand for diagnostic radiologists, with some shifting in relative demand for subspecialties. It is not clear if the decrease continued in 2004 or if 2004 demand was similar to that of 2003. Data are relative and do not indicate the employment market is weak in absolute terms.

How Much Do Radiologists and Radiation Oncologists Specialize?

PURPOSE

To present detailed information about the actual, current extent of the subspecialization of radiologists and radiation oncologists.

METHODS AND MATERIALS

The authors used data from the ACR's 2003 Survey of Radiologists and 2003 Survey of Radiation Oncologists. Multiple measures were used to ascertain the overall extent of the subspecialization of radiologists and radiation oncologists. Also, the percentages of radiologists and radiation oncologists in each subspecialty are reported. Multiple regression analysis identified the probable effects on specialization of characteristics of radiologists and radiation oncologists and the practices they work in.

RESULTS

Overall, 69% of posttraining, professionally active radiologists specialized at least to a small extent. Thirty-one percent of radiologists spent at least 70% of their work time in a single subspecialty. After controlling for other factors considered in the regression analysis, younger radiologists, those having taken fellowships, and those working in academic practices were more likely to be specialized; solo and locum tenens radiologists were less likely to be specialized. Forty-eight percent of radiation oncologists specialized at least to a small extent, whereas only 11% spent at least 70% of their work time in subspecialties. Controlling for other factors, radiation oncologists between 45 and 54 years of age had a low likelihood of being specialized, and the effects of practice type were the same as for radiologists.

CONCLUSIONS

Depending on the measure used, between one third and two thirds of radiologists were specialized in 2003. Radiation oncologists were less specialized, but approximately half of them specialized at least to a small extent.

A portrait of interventional radiologists in the United States

OBJECTIVE

In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists.

RESULTS

Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists.

CONCLUSION

Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology's 1999 Survey

OBJECTIVE

This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses.

RESULTS

Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs.

CONCLUSION

Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

Workload of radiologists in the United States in 2002-2003 and trends since 1991-1992

PURPOSE

To measure the workload of radiologists in the United States in 2002-2003, variations in workload according to practice characteristics, and trends since 1991-1992.

MATERIALS AND METHODS

Non-individually identified data from the American College of Radiology (ACR) 2003 Survey of Radiologists were compared with data from previous ACR surveys; all statistics were nationally representative. Workload according to individual practice characteristics, such as size, type, location, and setting, was tested for statistically significant differences from the overall average. Time trends and the independent effect on workload of practice characteristics were measured with regression analysis. Changes in average procedure complexity were calculated in physician work relative value units (RVUs) per Medicare procedure.

RESULTS

In 2002-2003, the average workload per full-time equivalent (FTE) radiologist was 13,900 procedures annually (standard error of mean, 200), an increase of 8.1% since 1998-1999 (P < .05) and 25.1% since 1991-1992 (P < .01). Academic practices performed 9900 procedures per FTE radiologist, and private radiology practices performed 15,200 procedures per FTE radiologist. Within most practice categories, radiologists at the 75th percentile of workload typically performed at least 50% more procedures than radiologists at the 25th percentile. Average physician work RVUs per Medicare procedure increased by 6.2% between 1998 and 2002 and by 21.6% between 1992 and 2003, mainly because of an increase in the share of more complex techniques such as magnetic resonance imaging and computed tomography in the procedure mix.

CONCLUSION

Workload per radiologist measured in procedures and RVUs increased steadily between 1991-1992 and 2002-2003. Because there is much unexplained variation, averages or medians should not be used as norms.

Are we headed for a shortage of burn surgeons?

Newly trained burn surgeons are in high demand but low supply. The purpose of this study was to quantitate the current need for burn surgeons and to identify the need in the future. A questionnaire was sent to the 159 burn care facilities in North America listed in the 1999 to 2000 American Burn Association Directory. Of the 159 centers, 9 surveys were returned stating the center did not exist. Eighty-four (56%) of the remaining 150 centers responded. Twenty-nine percent of responding burn centers are currently attempting to recruit another burn surgeon, and an additional 38% anticipate needing to recruit one within the next 5 years. Of these, 89% anticipate difficulty finding another burn surgeon. This survey identifies a need for burn surgeons now and warns of a severe shortage in the immediate future. Current burn surgeons need to ensure that any interested trainee be mentored appropriately toward a career in burn surgery.

Radiologist recruitment and retention: How can we improve?

Although recent data suggest that the shortage of radiologists is beginning to ease, radiologists remain in high demand. Academic and private radiology practices can take specific steps both to encourage the recruitment of new radiologists and to enhance the retention of existing staff members. The authors review the history of the current workforce shortage and describe steps they have taken within their own practice that have proved successful in helping fill staff positions and prevent the significant loss of staff members over the past several years. The authors believe that these steps can be helpful to any institution, private or academic, seeking to recruit and retain radiologists.

The private-practice perspective of the manpower crisis in radiology: Greener pastures?

Rising consumer expectations and a rapidly aging population point to a long-term shortage of all physicians, including radiologists. While attention has been drawn to the escalating manpower crisis in academic radiology departments, the private-practice perspective has been generally overlooked. Although clinical workloads and income are higher in private practice, studies have shown higher satisfaction levels (likely because of a greater variety of work) among academic radiologists. As the distinction between community and teaching hospitals has become increasingly blurred, there is now considerable overlap in the skill sets, sources of job satisfaction, and stresses that are encountered in both practice settings. Perhaps more than at any time in the recent past, diagnostic radiologists in academic and private practice share more in common than any perceived differences. Both groups must work together in concert with the ACR to address the growing manpower shortage, as well as the other challenges that confront diagnostic radiology at the beginning of the 21st century.

Types of Procedures Performed by Diagnostic Radiology Practices:Past Patterns and Future Directions

OBJECTIVE

The purpose of our study was to determine the types of imaging procedures performed by diagnostic radiology practices and the patterns and differences related to practice characteristics.

MATERIALS AND METHODS

The American College of Radiology (ACR) surveyed 970 practices by mail, using a 65-item questionnaire, in 1999. A response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. Trends were explored by making comparisons with data from a 1991-1992 ACR study.

RESULTS

Among the types of procedures studied, the highest percentage of multiradiologist diagnostic-radiology-only practices performed mammography (95%) and sonography (94%). (General conventional radiography and fluoroscopy were not studied.) The lowest percentage of these practices performed interventional procedures (69%) and MRI (77%). Solo practices showed less diversity in types of procedures performed than did multiradiologist practices and were a good deal less likely to perform each type of procedure except mammography and sonography. Generally, higher percentages of practices in nonmetropolitan cities or towns and rural practices performed various types of procedures than practices in metropolitan areas. Practice size, types of settings served (hospital or nonhospital), and practice type also influenced the number of types of procedures performed by a practice. The fraction of practices performing CT decreased from 91% to 83% between 1991-1992 and 1999. Percentages for other types of procedures were generally stable over time.

CONCLUSION

Certain practice characteristics play a role in determining the types of imaging procedures a diagnostic radiology practice performs. The decline in the percentage of practices providing CT and the failure during the 1990s of percentages for MRI and interventional radiology to increase from a relatively low base is worrisome. Future analyses based on a subsequent ACR survey will provide further insights into trends.

Residency training data: What do the numbers tell us?

The Accreditation Council for Graduate Medical Education (ACGME) regularly collects data on accredited residency programs that are useful for purposes of comparing resident demographics, turnover rates of program directors, and trends in program numbers and accreditation status. These data show that there are relatively fewer women in radiology residencies compared with other nonsurgical residencies. Women make up only 25% of core radiology residents. Further investigation is warranted to determine why this is so, because it will likely affect the ability to recruit female radiologists into leadership positions. Considering ACGME-accredited programs, those radiology subspecialties with the highest percentages of female trainees are pediatric radiology (45%) and nuclear radiology (44%). The turnover rate of radiology program directors is high (19%) relative to other specialties (14% on average), and this is being addressed in part by a change in the radiology program requirements. Other factors associated with this high turnover rate may also need to be addressed.