The Radiologist Shortage is Here

It should go without saying, but I’ll say it anyway: these are my opinions, formed from the combination of my biases, my experience as a radiologist since beginning residency 10 years ago, and my many conversations with radiologists across the country. You don’t have to agree with me.

Not Enough and No Help Coming

For today’s needs and today’s technology, we have simply produced far too few radiologists. There is a sizable and worsening radiologist shortage, and there is no end in sight on the basis of increased radiologist supply. There are currently 1788 separate job postings on the ACR job board. Imaging volumes are increasing between 3 to 5% per year (increasingly including low-yield complex exams), but no one is seriously attempting to address utilization at any level. Nationwide, the supply of radiologists is basically flat. The anticipated wave of retirements from vested PE buyouts is just beginning.

It’s true that reimbursement has been steadily falling and that radiologists have been forced to read more in order to maintain their income, but it seems that even there, any excess workforce tolerance for higher workloads has been saturated. If anything, the tighter job market after the 2008 crash and the desire to maintain income against that downward reimbursement pressure masked the problem. Burnout is now so rampant and commonly discussed that it’s mostly just meme bait on social media.

Turnaround times are worsening. For example, a memo to the medical staff of Ascension Saint Mary in Chicago was making the rounds back in March:

Our current Radiologist group, RadPartners, has been experiencing challenges with physician coverage for some time. As a result of this radiologist shortage, outpatient exams are taking anywhere from one to six weeks to be read.

Six weeks?! I don’t think most practices have much more to give before flaming out, and many groups are shedding contracts in an attempt to right-size their workloads. (This was in fact a contract in its final months that RP had already terminated. [Also note, given comments I’ve received: this quotation was included for flavor, not because RP or this one group is the basis for this article’s argument.])

There’s a generational shift contributing as well. People’s understandable desire to have a better lifestyle also means that in some cases we require more young radiologists to cover the jobs of those leaving the workforce. It wasn’t that long ago that most radiologists covered their own nights on a rotation (or paid for tele coverage) and no one had dedicated night teams. Then it was normal to see a 7-on/7-off schedule. Now 7/14 and even 7/21 schedules are increasingly common. When you need three people to do the job of one person, that isn’t going to help with the workforce shortage.

Frankly, I think there’s no chance of radiologists meeting demand without a paradigm shift of some kind, either the long-awaited mass efficiency gains from meaningfully helpful AI products (maybe good?) or the significant expansion of the role of midlevel providers in image interpretation (highly suboptimal and currently not permitted). It’s hard to imagine a world where volumes actually go down in this country, but that would also work.

The training pipeline is essentially fixed in size and long in duration. Even opening up more training spots would take years to help. If the shortage gets worse, then turnaround times will continue to lengthen (and patients suffer) and hospitals will struggle to get coverage (and patients suffer). That will be the time when the government/Medicare/national organizations start advocating against the currently protected role that radiologists hold for imaging interpretation.

Years from now, there may be a world where there are too many radiologists, but that world is one where radiologists are performing a substantially different role than they are today, and I’m not sure there’s any way to meaningfully prepare for that possible future while also solving the problem of getting today’s work done.

“It’s Cyclical”

A lot of radiologists, particularly people who have been practicing for a while, think things are just going to go back to normal. Radiology job markets are cyclical, the argument goes, there are hot markets and cold markets. Whenever the pendulum swings too far in one direction, it will swing back. This probably seems historically true. Various factors have contributed to historical “oversupply” including the 2008 recession, which cooled the job market as older radiologists put off their retirements, or the invention/implementation of PACS, which helped radiologists read more studies efficiently. But to assume that each swing of the pendulum is a predictable back-and-forth cycle correction to small shifts and underlying market forces I think misses a greater point about the difference in supply/demand for a professional service like radiology and some typical commercial widget.

I personally have yet to be convinced that there are any secular market trends pointing in that direction. The invention of PACS was a singular event that changed the field of radiology. It will take something equally momentous in terms of efficiency or work distribution to deal with the current and worsening workforce shortage. “AI” will likely be that paradigm shift, but it remains to be seen if those tools will evolve fast enough to help us with a shortage that’s already here. They simply aren’t ready yet to move the needle in anything close to the level we need. There will only be “too many” radiologists after a change whose timing may be impossible to predict and/or impossible to prevent.

The world we should want to see is one where radiologists use machine learning tools to produce higher quality more efficiently. The problem in the short term is that it’s very hard to argue only radiologists can interpret imaging when there aren’t enough of us to interpret all the imaging.

It’s also extremely challenging to combat rampant overutilization in our medicolegal and fee-for-service reimbursement climate. Neither the clinicians nor the patients want fewer scans, and radiologists aren’t actually paid to be gatekeepers.

It’s not hard to see that many non-radiologists (especially administrators) would feel that any read would be better than no read. Especially when some practices–overstressed, and yes, perhaps focused on profit–may be willing to produce substandard work, the delta between the trained radiologist and the less trained non-radiologist physician or NP/PA is going to seem smaller and smaller. Perhaps first it would be preliminary reads on DEXA, plain films, or ultrasounds. Maybe some places would start relying on machine-generated or midlevel prelims overnight in overtaxed EDs that can’t get coverage. It’s a slippery slope, they say, and they’re right. There are a lot of ways the specifics could play out, and we’ve seen it happen in other fields.

Currently, the shortage is helping combat falling reimbursement. Some rads see it and are pleased: we’re on the right side of supply and demand for income and job security.

But it’s also hard to protect turf that you can’t handle.

Hard to Make Predictions, Especially About the Future

So, yes, there will likely come a day in the future when there are too many radiologists. But in the meantime, there are far too few.

Some hospitals have been hard-pressed to find coverage. Imaging services, typically an important revenue source, are getting more expensive. If radiology moves from a profit center to a cost center, that impacts patient care and jeopardizes the important role that radiologists play in the healthcare system.

Early AI tools are no panacea, and automation bias alone–not to mention the costs and liability concerns–tells us that we don’t know yet how to best utilize their growing capabilities. So far, very few are making us faster.

If we can’t address the current workforce shortage over the next few years by adapting to new technologies and/or decreasing overutilization while working together to ensure that the quality of radiology services remains high, then we’re going to have a very hard time preventing the expansion of non-radiologists interpreting imaging.


Anonymous 05.09.23 Reply

One problem you haven’t addressed is the amount of unnecessary imaging that takes place. This is one of the major reasons why there is a radiology shortage. Hospitals have no reason to disincentivize inappropriate/excess imaging when they stand to make a profit. A partial solution is moving away from the fee-for-service model to the value-based care model. Unfortunately, this may lead to decreased Radiology salaries. However, CMS is decreasing reimbursement every year anyway. Might as well do what’s best for the patient and have a more manageable worklist that allows us to put out higher quality reports.

Another obvious solution is increasing the number of residency positions proportionate to the amount that imaging is increasing. Radiology residency positions have increased linearly while imaging has increased exponentially. It’s unsustainable.

The prospect of mid level image interpretation is unacceptable and we have to defend that to the death. Not even sure why you mentioned that as an option. The complexity of the imaging is increasing with better technology and a population that is living longer. We can detect more pathology and incidental findings than ever before. There are no easy exams. Anesthesiology became susceptible to mid levels because pretest probability allowed for triaging the easier patients. Also, you get real-time feedback when providing care. There is no Radiology equivalent to an ASA 1 patient in anesthesiology. If a healthy patient tanks in the OR under the care of a nurse anesthetist, the anesthesiologist can come in and take over. In radiology, the untrained eye will miss and not know the error is happening. We don’t find out about the mistake until the damage has already been done. Over the course of a shift, we see more patients than any other physician and also accept the liability that comes with it. The system would crumble with the amount of litigation against mid levels.

Value-based care is probably the future. We need to get back to aggressively protocoling and maybe even blocking certain exams. Certain practices will need to die. For example, repeating imaging because we don’t trust the outside read. Or performing suboptimal trauma protocols at level two / three trauma centers and having the imaging repeated at the level 1 trauma center. There are many other things that can be done to get the list under control. Mid-level image interpretation is not one of them.

Ben 05.09.23 Reply

I referenced it in the beginning and put “decreasing overutilization” in the last line of the article, but you’re right that addressing volumes directly is I think the least likely solution to actually happen. Volumes have outstripped our capacity. Taking care of either side of the equation would work, and getting rid of low-yield exams is the exact right route for optimal patient care. But if imaging earns money for facilities, as you said, there’s no incentive. I think in our fee-for-service model, that’s simply not going to happen at scale until/unless radiology shifts into being a cost center. And I suspect most hospitals and academic centers would rather do whatever it takes to keep radiology profitable.

It’s also currently an unpaid task, and I suspect most practices would rather give up work they can’t staff than spend more non-renumerated time and effort fighting low-quality exams. I don’t even think most facilities are interested in reigning in their ordering providers. They care about insurance coverage and throughput, not utility. I think such efforts would be much more successful on a nationwide scale.

I suspect value-based payment model changes will lag far behind the need to deal with the shortage. Same problem with residency expansion. The status quo is unsustainable, but adding new spots will take 5 years to be helpful, and I suspect there’s going to be serious pressure for at least a partial solution before then.

I would much rather radiologists take ownership of the imaging pipeline and stop the growth-at-all-costs that’s plaguing healthcare today, but I am not particularly optimistic. When places like UPenn are using radiology extenders for interpretation (and publishing about it!), it’s not hard to see a scenario where some facilities would be eager to incorporate midlevels despite the obvious downsides to doing so. Some legitimately helpful AI tools that actually integrate well with PACS and PowerScribe and that include customized natural language processing would probably help us avoid that fate. It’s probably not wise for our field to hang its hopes on a technological solution instead of overcoming our inertia, but I haven’t seen much evidence that people are mobilizing meaningfully on that front.

Anonymous 05.09.23

Thanks for the thoughtful response. I think that the current radiology workforce can hold the line for the next 5-8 years while the next crop of radiologists is being trained. However, the ABR needs to help by changing it’s board certification timeline so that we are producing board certified radiologists upon completion of residency. Credit to you for addressing this on many of your other blog posts.

The majority of the excess imaging does not require a subspecialist radiologist to read. We need more generalists, especially if hospitals want 24/7 coverage. Part time fellowships need to be allowed and the archaic and prohibitive ACGME requirements need to be revised or eliminated. There’s no reason a neuro fellow should only be reading neuro exams for a whole year and foregoing participation in the understaffed general radiology workforce. Also, it’s inefficient to require all of the fellow’s studies to be signed off by an attending for the whole fellowship despite the fellow proving competency early on in the fellowship. Graduated responsibilities should be granted as competency is proven. They should be signing off on noncontrast head CTs a month or two into fellowship or as their program sees fit. For all fellows, the lack of board certification unfairly limits the opportunities for locums work, and I’m sure they would be eager to moonlight and make extra money while also helping out a local practice. We need to eliminate the ACGME stranglehold on neuro and Pediatric fellowships to increase fellow participation in the general radiology workforce and fill the gap. If this thing falls apart, the ABR will be largely to blame.

Ben 05.09.23

Unfortunately some of the current issues are based in CMS for the ACGME fellowships (an ACGME fellow cannot final sign anything in the domain of their fellowship, so a neuro fellow cannot final sign a head CT even though an MSK fellow could; it’s obviously not about patient care). We would need to pull fellowships out of ACGME in order to solve some of these issues, and that means pulling out of funding. Seems unlikely, though I agree the current paradigm is pretty silly. The importance placed on a one year training program is so outsized compared to what you actually practice. I’m a neuro-rad because I read neuro every day, not because of my fellowship.

I wish the ABR would take the pulse of the situation and really go at their certification pathway from the perspective of what radiology would actually benefit from. They’re hamstringing the field.

roger 05.10.23 Reply

Here are my thoughts on the issue:

There isn’t as much a labor shortage as there is a labor shortage at a particular price point. You site RP and Ascension in Chicago – two of the absolutely shittiest outfits to work for – RP because it skims 30% of what the radiologist is generating and is constantly downward adjusting the pay structure for it’s employees on a $/wRVU basis (i mean physician partners) and Ascension – most poorly led organization which has alienated most competent physicians by re-assigning contracts to Premier (in the radiology world, which then sold out to RP) and trying to eliminate as much nursing and other ancillary help.

RP gave up that particular contract b/c it’s business model wanted to generate X profit and in reality, it had to pay Y and barely make profit or more likely loose money. I guarantee you that if RP offered 2x current pay scale, the backlog would disappear. Given that RP routinely skims about 40% of the wRVU pay (i am not making up #s here), it’s not an issue of “labor shortage” but ” no one wants to work in this crap environment practice at the pay”
This was predicted by many and has fortunately, come to fruition.

In a similar light, hospitals can absolutely offer additional money to cover shortages which would pull in people from the part time pool or people who don’t mind taking 2-3 weeks less vacation. The profit in imaging is on the equipment side (hospitals) where the “facility charge” is 7x the “interpretation” charge (and sometimes 15x)

The other issues are what I call “wild expectations” of services provided in house at every location and at all times. Most all practices do not need to provide say GI or arthrogram coverage at small locations or say breast coverage every single day. These services can be consolidated in 2-3d a week which would allow for a much more flexible work environment remotely, higher productivity, less burnout/more working days for the existing work force.

Similarly, outpatient exams do not need to have a 24 hr turn around for issues that have been present for months/years – “weight loss…abdominal fullness for 2 yrs…chronic knee pain MRI” – it doesn’t matter if these are interpreted in 12 hrs , 24 hrs or 72 hours. It’s an arbitrary # created by admins about 10 yrs ago to control private practices. (i do agree 6 weeks is too long, however, these sort of delays are only present in dysfunctional VC practices)

It is also mostly unnecessary to have dedicated multi specialty coverage over the night – yes, it can be helpful in a case here or there but for the most part, it is not, and things can wait till 4 hrs later if a truly subspecialty read is needed

Lastly, i see a lot of inflexibility in the way we run our practices. I dare say that if my group opened up a model where i could log in after a regular day and choose to read 5 or 20 cases and be paid on per wRVU basis, our lists would substantially shrink. however, in this group, and many others, this “only slightly creative thinking” is constrained by some combination of “jealousy” about some people making more and just inability to think outside a very small box.

Lastly #2 – it’s unclear when the radiology department will go from revenue generator to cost center. If it does, or if there is even a 10% disruption by AI, this entire paradigm will change significantly. Since the lag time between training rads and matriculation is so long but also has such long practice cycle where that radiologist is likely to practice for another 25 years, even if conditions are unfavorable, expanding training slots without a concrete steps on how to decrease them again when demand/supply dynamics change is in my opinion foolish.

In summary, I don’t think there is as much a radiologist shortage as there is a shortage at reimbursement that VC backed practices are offering to pay, pay that is about 40-60% less than what the same practices generated on a per wRVU basis just 5-10 years ago before they were “acquired”. What one is being paid as a daily rate is meaningless without knowing how “brain busting” that day is. At many of these outfits, the requirement is to interpret about 60-80wRVUs on MSK or general rotations because the pay/wRVU is below medicare rates (yes RP in Ohio, i am looking at you, paying 50c on the dollar of revenue generated by the radiologist). It’s therefor no wonder that there is a burn out and no one wants to fill these shifts.

It’s not a lack of manpower. It’s lack of interest in working for 50c/dollar for horrible organizations.

Ben 05.10.23 Reply

I included that particular example because it was interesting, but I honestly do not believe even a little bit that the current problems are limited to outfits like RP. It’s nationwide and affects independent groups. And yes, by the laws of supply and demand, both the supply and demand sides of the equation depend on the price point. Absolutely no doubt about that. Pay everyone double and the work gets done with no problem.

I don’t personally think increasing the training pipeline is going to do much, as I alluded to in the post. By the time such help comes, the ground will have probably already shifted.

As for flexibility and expectations, absolutely. High-touch service will increasingly command a premium and some of it is simply going to have to do away. Groups are going to have to be creative in incentivizing list-crushing. My group and many others do have “after-hours” work on a per-click basis.

Anon 05.13.23

My group allows after hours per click pay and literally no one does it unless our night service cannot keep up and the ER calls us to clean the list.

We are a small private group covering one contract and had to recruit for 2 years to get someone (thankfully we did). He’s not the brightest bulb in the bunch, but he can get through the work and he’s not a pain in the ass, so we consider ourselves lucky. Our TAT for all exams is <20 hours and we are proud of that, but during recruiting we noticed two things applicants wanted that we could not offer: flexible WFH and large amounts of subspecialty work. I guess it's good to know I could walk into basically any practice and get hired on the spot as a generalist, but I wouldn't exactly call that "leverage".

Good luck to midlevels and their overlords who want to accept that giant throbbing migraine of a liability. Plain films aren't as easy as everyone thinks they are.

Matt 05.11.23 Reply

A short term and reversible way to increase number of radiologists would be to focus on specialization in the fourth year of residency, and then shorten (6 months) or skip fellowship. There is a setup for this already with mini fellowships. As the shortage eases, this could go back to a full year of fellowship.
I do not think the board timing has much effect. Graduating residents or fellows are board-eligible, which is typical for other specialties. This did not affect my ability to get hired a few years ago, and CERTAINLY is not affecting it now.

Anon 05.11.23 Reply

It was a big shortage while I was training and then the bottom fell out of the market. 7/7 night jobs paying in the 2s and few jobs in my state. The shortage is good for us since we have no other leverage. Let’s enjoy it while it lasts.

Bob 05.13.23 Reply

Interesting perspective.

I think if anything the mid levels will start doing the easier things like plain films ultrasounds mammo etc.

Mammo especially. Those rads need to stop acting like they’re saving the world and realize a PA could easily do 98% of their jobs.

When that occurs no more rad shortage…

J t Simmons 05.14.23 Reply

Certainly true for screening mammography

Mark 05.14.23

Bob and JT, perhaps you can be the first to schedule your wives and/or daughters for their screening mammograms with the “trained” midlevels and set the example?

Murray Arthur Solomon 05.14.23

In 2 years AI will be reading mammograms

K sera 05.30.23 Reply

I think we all know that there’s a ton of negative neuro – CT and ultrasound cases that a non rad reader can cherry pick and leave the hard cases for the rest of us rads . I read mostly mammos now – but don’t tell me you’re not worried the cherry picking can get rid of a large number of radiologists even the specialists.

1. Put any case (CT – MRI etc etc )through an AI system
2. If the case is negative by AI standards feed it to the Non-radiology readers
3. If it’s positive by the AI algorithm for an abnormality give it to a Radiologist.
4. The Non-radiology reader is not comfortable with case even though AI blessed or negative – put it back on the table for a radiologist to read .

AI is an amazing concept – I saw that our jobs collectively vanish in due time .

But you know we’d be better techs in our old age because we know what we are looking for .

I’m currently in need of docs like you all to reverse fight being able to do mammograms at my office as I can’t find good techs . Did you know the ARRT snd DSHS won’t allow us to do mammograms without a tech license – (we are suppose to go back to school and acquire a tech license or ARRT that takes two years to do a mammogram which is just a simple X-ray .

Let me know if you could help me fight the fight in this matter? I’m shocked thst anyone but a radiologist will read radiology in the future .

You’ll burn out too. Just know that no one is safe! Not even a neuroradiologist as you mention


Anonymous 05.13.23 Reply

Must fight against any encroachment by midlevels.
Most Fellowship-trained radiologists are rapidly giving up on-site procedures in order to read remotely.

If exclusivity of interpretation is lost to mid levels, would be impossible to reverse as long as the economics favoring mass cheaper labor persist.

God forbid the UK style ‘apprenticeship’ to meet GP shortage ever crosses the Atlantic.

RadLove 05.14.23 Reply

Complex exams requiring subspecialty reads can be impossible to cover, such as Cardiac Imaging or high level Neuro. Hospitals don’t seem to understand this and should divert them from community hospitals to academic institutions who enjoy high subsidies to cover these services.
We have IR Rads covering 10 sites, generating about 20 RVU/day “because they’re always driving” and should allow PAs to run around and do para/thora/thyroid biopsies. IR Rads should be focusing on high level IR or reading cases. This has to be made clear to the hospitals that if they want a Rad in transit all day, they need to subsidize his/her salary, not the diagnostic Rads expected to cover them.
Working remotely can save hours in commuting, allowing more time to read cases, which is the end product the client is desiring. This shouldn’t be hard to understand and should be encouraged. Paying someone less or withholding partnership because someone is remote simply makes no sense. I would be spending 4 hours/day in my car if I were required to be on site. Also paid overtime at a 1.5x rate should be standard practice everywhere. Some people have extra capacity, others don’t.

dontworkforPE 05.14.23 Reply

Game over if we allow midlevels to the degree that they function in other specialties. If you fear private equity now, wait until they staff the rads department with half midlevels, half radiologists. They would rake in the money which would allow them to expand well beyond their current footprint, even in this high interest rate environment. Once they have monopoly status and a radiology surplus, they would then slash radiologist salaries across the board and skim more off the top than they already do. So yeah, we should fight midlevel encroachment to the last breath. Private equity care more about money than quality and patient outcomes. Fingers crossed that private equity in radiology dies out before midlevel encroachment becomes an issue. It sounds like they are on their way if they think 1-6 week outpatient TAT is completely out of their control. It’s not- they just don’t want to pay for the fix. I don’t think you can find a single private practice group with that kind of TAT, even the ones near implosion. So I think it is a bit misleading to use that data point as somehow remotely representative of the current shortage as a whole. Radiologists should do their part to take advantage of this current shortage to avoid PE like the plague. It will be interesting to see what happens to these profit extracting entities when all the radiologist sellouts vest and leave or retire.

Ben 05.14.23 Reply

I included it late in the draft as an anecdote, it was not the basis for the argument. Given how many people have fixated on that little quotation, I probably should have omitted it. I agree there are probably no groups out there with times anything remotely close to that in real life. I assume the TATs for even that group were mostly in the 1-week range. Nonetheless, TATs are overall getting longer, groups are shedding their worst contracts, and some hospitals are already struggling to find coverage. These are real trends.

The perhaps ironic part of the midlevel push is that academic centers ultimately have a similar model. The difference is that the profits go to an ostensibly non-profit university and not to a third-party for-profit company. I am worried about the UPenn’s of the world using and promoting the use of RAs almost as much as I am about RP employing an army of midlevels.

dontworkforPE 05.14.23

I agree with you that the shortage is 100% real and TAT trends are upward. I also agree that private equity is not the major factor. Without a doubt, the major factor is an aging workforce. I can’t prove this, but I know it to be true- baby boomers are the hardest working generation in terms of hours and years they are willing to work. At odds with this- new radiologists seem to increasingly want work-life balance. Anecdotal, but I hear stories of new radiologists looking for part-time work or employee jobs with 16-20 weeks vacation out of the gate. ACR said just last year that over 50% of all radiologists are over 55 years of age. How many of these rads are within 2-3 years of retirement? 4 to 5 thousand? I don’t think we can know for sure, but you only have to look around you to find at least 1-2 people of 10 in your group that says they want to retire in 2-3 years.

Add to that ever increasing volumes, and we may be in for a real newsworthy crisis in 2-3 years time, something that could even force bipartisan legislation. And I hope that the response isn’t to allow midlevels to read imaging. A lot of lobbies would love to see that happen- midlevel lobby, private equity lobby, megahospital lobby etc. Quality radiology and patient outcomes will worsen if that happens, but hard to stop a well oiled and well heeled lobby machine that puts profits over patients.

Anyway, I enjoy reading your blog. I hope that at the very least it convinces radiologists to shun private equity as a job option. That is perhaps the one thing we do have control over as individual radiologists. With so many jobs out there, don’t choose private equity. It may only help the shortage a bit, but it’s better than nothing.

Bob 05.14.23 Reply


Again just showing that lots of radiologists only care about the bottom line — and not actually meeting the needs of the patients we “serve”.

Midlevels can and WILL be a part of radiologic care. You’re telling me that a PA can’t interpret mammograms since there’s like a 95%+ negative rate?

Give me a break!!!!

The groups that win will be the ones that adapt. This old school baby boomer thought process got us into this mess in the first place

Then posting generational bs about work ethic etc

Hey buddy guess what? There were probably 600 more medications I had to know in pharmacology than you. And countless other things in medical school.

Oh and when I stated in private practice I had to be about to interpret fast right out of the gate—- not after years in practice.

Get real

Bob 05.14.23 Reply

Look I may just be a lazy dumb millennial radiologist who happened to produce 19600 rvus last year


I can do basic math. As a whole the volumes won’t be met with the current workforce.

Something has to give

If anyone wants to start an online school teaching PAs how to read negative mammograms, let me know. It does not take 5 years of training after internship to do this….

Larry 05.14.23

An online school to teach PA’s how to read negative mammograms? Im in! Sounds like a win win situation. Cant lose. But what do we do with the positive mammograms? do we throw them in the trash and pray ? Pls clear up this part before i send my hard earned money after another “promising” investment opportunity. You know, us docs arent the smartest when it comes to speculating in the markets.

Dissappointedbybob 05.15.23

So you would sellout our specialty? Good to know. I always wondered how midlevels might get into image interpretation. It’s because of people like you lining up and ready to train them. I hope I never have to receive care from someone you trained for 3 months for something all of us spent years honing during training and as attending radiologists. The fact you see no problem with that makes me think you’d also sell out to private equity. It’s sad you don’t care about patient outcomes.

Charles Knight 05.16.23


I am a highly trained neuroradiologist in practice (post fellowship) for 17 years, 13 of which I did mammography. I mainly do CT/MR currently, however I gained lots of respect for screening mammograms, which are imo are the hardest thing in mammography, not the easiest. It takes seeing thousands of them (the “negative” studies) to get truly excellent at them. They are the gateway to the truly easy “algorithmic” studies (see a “mass” on screening, get diagnostic, if mass persists with compression, get US, is it a cyst or solid, solid = biopsy most of the time, etc, etc).

Do NOT get underestimate easy “negative” exams, in any modality. Sure, anyone can read a “negative.” But you can you see the “subtle positive” after 50 negatives in a row? That is a major area of expertise, not just being able to read a cranial nerve study with subtle findings at the forsaken rotundum.

If you disagree, as another poster said, I invite you to have your loved ones screening mammograms (or their “usually negative” head CTs) read by a mid level (or a neurorad fellow just starting a general practice ), rather than the mammographer who has read 15,000 screeners. I have a feeling who you would choose/

Middle levels reading “negatives” would be a major decline in quality of patient care and should be avoided at all costs.

I agree with another posting that our education could be curtailed. You could probably shorten med school itself to 2-3 years (biochem really necessary? 4th year? Cmon), residency to 3 years, fellowship should still be one year. But that won’t happen until things get truly desperate.

Anonymous 05.14.23 Reply

An additional short term solution would be to get rid of the ridiculous requirements that radiologists do a clinical internship. Prior to the ABR mandating the internship 10% of the spots had no such requirement and those positions were the most competitive. Why have we lengthened the training to supply interns to other specialties. Literally no one would know who trained in radiology without an internship. Maybe the combo IR/DR gets some benefit but an imager quickly forgets the thing’s learned from doing the mundane work of an intern. This in turn will make radiology more attractive to those coming out of medical school. I really wonder why this isn’t happening or at least being discussed.

Bob 05.14.23 Reply

Because medicine has an “I had to do xyz bs they should too” mentality


Oral boards again?

What a joke

Richard Chesbrough, M.D. 05.14.23 Reply

One idea: Does the ACR have a refresher course for older, retired radiologists who want to work? I myself might be willing to rejoin the work force 10-20 hours a week if that would help. But I would need a couple months of retraining to feel good about it. I think there’s probably a sizable number of us “oldsters” still around.
Could that help?

Ben 05.18.23 Reply

The ACR has a variety of courses. Another large radiology learning platform would be Medality (formerly MRI Online).

Bob 05.15.23 Reply

Disappointed by Bob

How many boomers sold out my generation of radiologists by allowing private equity to buy their practices?

Our specialty will not be able to meet demand soon.

Please re read that statement.

Our specialty will not be able to meet demand soon.

Think about that. What is your solution? Oh you want to pretend it’s not happening.

Bob 05.16.23 Reply


I’m a fellowship trained breast imager.

Try and stop me from figuring out a way to get an army of midlevels doing the work.

There’s no way there would be a statistically significant difference between PAs trained 6 months and general radiologists.

Zero. Chance.

Your egos are MASSIVE.

Jason 05.17.23 Reply

2 concerns I have:

Risk or burnouts. Our hospital, like most have suffered from delayed telerad TATs. The EDs solution is for us to be the backup to the backup, which for a small group like ours who has 3 in house rads would cause rapid burnout, which is the reason we have refused so far.

Secondly, the do-it-all general rad that can read all modalities and do most non vascular IR procedures is a dying breed. We have 3 capable rads that are either IR, angio, or body interventional trained. I’ve tried explaining to the hospital that they have been spoiled by what they have and don’t realize what we do is not the norm for a small community hospital…crickets. Instead, they think we need to hire a full time IR, which I explain is not going to happen unless it’s someone in the twilight of their career looking to retire soon. We do all basic IR stuff, biopsies of almost any location, drainage catheters, kyphoplasty, ports, ivc filters and pleurx catheters. Not to mention the splitting of residency into diagnostic and IR will only compound the problem.

I have never felt such great job security in my 14 years since finishing training, but at the same time I am frightened at what will become the state of radiology in the next few years. I’m not sure, outside of radiology, the hospital admin understand the looming crisis.

Ben 05.18.23 Reply

Thank you for sharing. No doubt the IR/DR split and DR’s drift away from “light IR” is a real problem for small to mid-size hospitals.

KT 05.17.23 Reply

While likely unpopular in an atmosphere were volumes mean revenue, how about we work to control the input. If we have little (near term) ability to control the output (number of rads emerging from training); and the AI/PA options are both polarizing, perhaps not desired, have the short-term potential to negatively impact care and will take years to implement, only option is to focus on reducing the input. It’s the only other lever to pull. The CT is not a stethoscope! The quality of imaging and information provided is so good (not to stroke your egos), that referring docs (especially the younger crowd) rely on it in some instances over conventional but meaningful history and physicals. What happened to actually “practicing” medicine? Now we just collate information, run an algorithm which points to a solution?

Bob 05.17.23 Reply

Throughput = $$$

People follow incentives

Take the boomers who sold out my generation of radiologists for example….

Roger 05.25.23 Reply

One thing is pretty clear. Bob is a troll and a non radiologist. Someone with very crude understanding of what is involved in image interpretation wasting our time. Best to leave it at this and not waste more time.

Chris 06.01.23 Reply

Agree with Roger…Ignore Bob the troll who thinks he can train anyone off the streets in 3 months to interpret breast imaging.

Frank 06.19.23 Reply

There’s not ONLY a shortage of Radiologists. Utilization control is a pipe dream. Walk through your ER. As a comedian said, “Must be hell to work in that environment!” And who do the consult with? Our hospital has no Urology or GI coverage 1 week a month and some other specialists, never. They are judged on their “door to disposition” times. Practice of medicine now includes a trip through the “diagnostic donut”, the “magic answer machine” as our ER docs call it. They don’t have time for a complete history and physical and a lot of ER care is provided by PAs who legitimately need our help.

Frank 06.19.23 Reply

Like so many other aspects of current life, we have the flame throwers (you figure out who that is in this thread) and the complainers (most of us) and those who point out the problem everyone already knows.

Solutions? Harder to come by. Likely impossible in the short to medium term in this case.

Important to understand a Problem vs a Predicament and a Dilemma.

Problem. Has a solution.

Predicament. A situation without a solution for which a mitigation must be sought.

Dilemma. A Predicament which requires a choice between unacceptable alternatives.

We have a problem, but it is long term. Maybe solved by AI. Maybe someday utilization can be controlled. Maybe we can right size the Radiologist supply. Maybe mid-levels play a role. All must be on the table and discussed.

What we have now is a Predicament and a Dilemma.

The importance of understanding this is that time wasted on finding a solution for the problem deployable in the short to medium term is time that should be spent seeking a mitigation and making the hard choices forced on us by our current dilemma.

We need to define how many wRVUs per day, per year, is too many. There is a number.

We need to calmly discuss the potential role of “mid-levels”.

In the short term, we need to define appropriate wRVU max per day and try to get as many Rads as possible near that number.

In the short term, we need to take steps to facilitate retired Radiologists re-entry to the labor force, in what ever part time capacity we can.

Emmit 07.15.23 Reply

55 percent of medical school students are now female and 40 percent of them either quit or go part time six years after graduating residency. So a large portion of the tax funded/Medicare residency positions are training part time or short term doctors.

Ben 07.15.23 Reply

I think the issue there is with medicine and society and not the people in it.

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