The United States is facing a looming doctor shortage. The Association of American Medical Colleges (AAMC) predicts that by 2025, the U.S. will have 130,600 fewer doctors than it needs to meet patient demand. Physician demand will only increase thanks to the Affordable Care Act, which gives more Americans access to health care.
Many of the nation’s approximately 34,000 radiologists are 55 and older, and the procedural workload is growing about three times as quickly as the graduate pool. Even though medical schools are enrolling more students, they still won’t be able to keep up with demand. Additionally, an aging population, overall population growth and physician burnout all contribute to the shortage.
Even with increases in the number of radiologists and increased productivity thanks to technology, the AAMC predicts a continuing shortage of 4,000 radiologists by 2020. Compensation isn’t the issue; in some instances, radiologists command salaries almost twice as high as those of primary care physicians. Solving the shortage will require a two-fold strategy: recruiting more radiologists into medical school and covering current shortages with remote radiology services.
Recruiting New Radiologists
Too few students apply for medical school because they perceive gaining admission as nearly impossible. They also avoid medicine because of the overwhelming student debt load. In many cases, the cost of becoming a radiologist in the U.S. is double what students pay in other countries. For example, in India, a master’s degree is sufficient to gain employment as a radiologist unless students want to train for a specialty such as interventional radiology or oncological radiology.
Some experts argue that the U.S. physician shortage is less about quantity and more about distribution. In a recent Wall Street Journal piece, Dr. Bob Wachter, associate chairman of the Department of Medicine at the University of California, San Francisco, pointed out that America is one of the few industrialized countries that doesn’t intervene to appropriately distribute doctors throughout different specialties and different geographic areas. Wachter suggests that changes to government subsidies can encourage enrollment in shortage areas like radiology.
Covering Shortages With Remote Radiologists
Since competition for radiology graduates is fierce, graduates are setting job terms that are advantageous to them but not necessarily to hospitals and patients. Dr. Atul Grover, AAMC’s public policy director, cited radiology graduates that were scoring not only top-dollar contracts but also eight or nine weeks of vacation time per year and no calls. This limited radiologist availability exacerbates coverage problems. In many cases, the best way to cover shortages is to work with teleradiology providers and with on-site radiologists.
Dr. David Levin, professor and chairman emeritus of Thomas Jefferson University Hospital’s Department of Radiology, has been an outspoken teleradiology critic. He suggests that teleradiology gives physicians in other specialties a negative image of radiologists, casting them as physicians who only want to work from 8 a.m. to 5 p.m. and who refuse to be on call. In reality, the radiologist shortage is allowing new graduates to set those types of terms. It’s the professional environment, not the teleradiology provider, that creates a negative image of some radiology practitioners.
On-Site Radiologists and Teleradiology
Some remote radiology services provide on-site coverage for radiology staffing shortages. They work with hospitals and outpatient centers to provide qualified on-site personnel during coverage gaps. The best on-site personnel not only interpret scans but also build relationships with other medical providers. They also conduct outreach to hospital and outpatient center referral bases.
When on-site coverage isn’t possible, many health care providers turn to teleradiology. Using PACS or other means, doctors send digitized patient scans to remote teleradiologists. Teleradiologists then interpret the scans and send the results back to doctors. Particularly in emergency situations, such as those faced by ER physicians, sending scans to remote experts for quick interpretation helps doctors to save lives. Even in non-emergency cases, teleradiologists can provide crucial early diagnoses for diseases like cancer, increasing the likelihood of effective treatment and remission.
Until the U.S. addresses its chronic radiologist shortage, remote radiology providers continue to deliver much-needed patient services. As imaging technology improvements, aging patients and insufficient medical school enrollment increase radiology workloads, many health care providers have no alternative but to seek outside assistance.
About the author: Harold Capoldo is a freelance health care writer.
