It’s becoming clear that subspecialization is an upward trend in radiology, but the majority of practicing radiologists—55 percent of those in the U.S.—remain generalists, researchers announced in a recent study.

The study combined data from more than 33,000 American radiologists who billed Medicare between 2012 and 2014, Richard Duszak, MD, and colleagues wrote in Radiology. A validated classification system was used to map radiology services to seven subspecialties and quantify subspecialty-focused work.

“Overall, the goal is making sure we right-size our radiology workforce and provide the best services to our patients at the right time,” Duszak said in a release from the RSNA. “It all sounds a lot easier than it is.”

Right-sizing, he said, means making sure a patient’s needs are matched to a physician’s talent, regardless of where doctors are trained or where either individual chooses to live. In addition, a radiologist’s length of time practicing, the size of their practice, and gender and academic status were also sizeable factors in that physician’s decision to subspecialize or not. According to the research, younger physicians were more likely to subspecialize.

Andrew B. Rosenkrantz, MD, who co-authored the study, said there’s a general push toward greater subspecialization—but that might not work for every area.

“If a patient lives in a rural area with only five radiologists covering a portion of a state, not everyone can be subspecialized,” he said in the release. “The idealistic answer may be that everyone is a subspecialist. The realistic answer is that a robust generalist radiologist workforce is needed to provide proper coverage and imaging to people all over the country.”

Fifty-five percent of radiologists predominantly practice as generalists, the team found, but those doctors still devote an average one-third of their work time to a specific subspeciality. Among radiologists practicing as majority subspecialists, 10 percent were neuroradiologists and 8.4 percent were breast imagers.

“While there is a lot of talk about increasing radiologist subspecialization, we have to recognize that generalists still represent slightly over half of radiologists practicing today,” Rosenkrantz said. “Radiologists who are just finishing training today can look at this research and understand that they should be prepared to handle more than just that one subspeciality and that their jobs might change over time.”