A host of healthcare topics received due attention at the June 2024 AMA Annual meeting, and a number of the discussions were relevant to radiology. Discussions about the physician workforce shortage, however, were of particular interest. It is clear now that the workforce challenges once on the distant horizon have arrived for many specialties, including radiology. Interestingly, in 1970, Herb Abrams wrote about the “Manpower Shortage in Radiology” due to “the imbalance in the supply-and-demand equation and the inexorable increase in the number of radiological examinations” — and “the growing unwillingness of many physicians to handle medical problems without every possible safeguard and guarantee that nothing has been missed”.

Fast forward a half-century later and here we are again, talking about the radiology workforce shortage. The reasons for the demand-versus-supply mismatch have been detailed in a variety of articles and workforce surveys and include the following: 

• The United States population has grown more in proportion than the number of radiologists being trained per year.
• The number of federally funded GME training positions has been relatively flat for the past 30 years.
• The number of non-physician and physician providers has grown more than the number of radiologists — ordering more studies per provider (especially non-physician and emergency department providers).
• The number of radiologists retiring was accelerated by the Great Resignation during the pandemic.
• Cancer is now a chronic disease and the imaging needs of patients with the disease has grown.
• The number of images in and complexity of each study have increased significantly, making each study more complex and time-consuming to interpret.

Addressing this problem will require a multi-prong approach and a willingness by radiologists and their practices to adapt and make sacrifices. A recent article in the American Journal of Roentgenology (AJR) by Rawson et al. details short-term strategies to try to manage the shortage of radiologists. The tactics are divided into three categories: people, process and physical plant (meaning physical infrastructure). Under the category of “people,” the authors suggest asking part-time employees (who are able to do so) to work one more day a week and/or hiring reading room assistants to optimize radiologists’ workflow. The use of retired radiologists has also been suggested to help with the shortage of radiologists. Hiring non-physician providers for various minor fluoroscopic or ultrasound-guided procedures is also listed as a tactic, with specific recognition that the physician extenders must be under the direct supervision of a radiologist to obviate concerns about scope creep. For academic institutions with ACGME-accredited training programs, employment of internationally trained radiologists as faculty for the last three of their four years of training (as part of the ABR alternative 4-year training pathway) and use of U.S.-trained fellows to work a few weekends per month were also suggestions.

Addressing this problem will require a multi-prong approach and a willingness by radiologists and their practices to adapt and make sacrifices.

For the category of “process,” the authors proposed buying back some vacation time (especially from radiologists who receive 12 or more weeks per year of vacation/professional development time), providing home workstations for all radiologists and allowing them to intermittently internally-moonlight and read from home for a few hours as needed, and contracting with teleradiology groups to provide “final reads” versus “preliminary reports” that must be over-read by a member of the practice.

In terms of “physical plant,” in addition to home workstations, the ergonomics of the workstations (keyboards, lighting, tables with height adjustments, etc.) were emphasized as being important for the physical well-being of radiologists. While AI algorithms and tools hold promise and will eventually help radiologists with process and workflow improvements, report generation and computer-assisted detection of abnormalities, whether AI will significantly benefit radiologists in the near-term in not yet clear. The strategies and tactics provided in the AJR manuscript can be tailored to the unique needs of various groups. However, ensuring that radiologists’ physical and mental well-being are maintained and burnout is averted requires regular monitoring and the recognition of its importance.

While some of these strategies and tactics may be employed for the short-term, the College will also continue to be vigilant in pushing for a legislative fix to provide longer-term solutions. This encompasses increasing the number of physicians who are able to practice in the U.S. These efforts will include partnering with an ACR-led coalition of healthcare associations to advocate for: 

• Enactment of the Resident Physician Shortage Reduction Act (H.R. 2389/ S. 1302), bipartisan legislation that would increase the number of federally funded residency positions by 2,000 annually for seven years (14,000 total); 
• The reauthorization and strengthening of the Conrad State 30 and Physician Access Reauthorization Act (H.R. 4942/ S. 665), which would expand the number of J-1 visa waivers for international medical graduates from 30 to 45 per year to practice in medically underserved areas for three years; and
• Support for the Healthcare Resilience Act (H.R. 6205/S. 3211), which would recapture up to 40,000 unused employment-based visas (25,000 for nurses and 15,000 for physicians) so these international graduates are able to remain and work in the U.S.

Additionally, the College will continue to advocate for and invest in the Appropriate Use Criteria (AUC) Section of the 2014 Protecting Access to Medicare Act (PAMA) as a utilization management and clinical decision support (CDS) ordering tool for advanced imaging studies for inpatients, ED patients and outpatients to reduce inappropriate use — thereby reducing the workload for radiologists. Of note, use of this CDS tool based on the AUC is estimated to save CMS $2 billion over a 10-year period. 

Addressing the shortage of radiologists will be challenging for the foreseeable future. However, as per the Stockdale paradox, we should remain both hopeful and realistic as radiology and radiologists will adapt, advocate and develop new tools and technology in our efforts to address this workforce conundrum sooner rather than later. That’s what we have done in the past and will continue to do going forward.

For more on the radiology workforce landscape, follow recent ACR Bulletin articles on mitigating the impact of staff shortages and rising study volumes.