Why many IR providers do not practice in rural hospitals, smaller communities

Rural hospitals and smaller communities have a harder time recruiting and retaining interventional radiology (IR) providers, according to survey results published in the Journal of the American College of Radiology.

Additionally, the survey results highlighted that rural hospitals are unable to meet service demands like their urban counterparts can.

“Although a number of studies have demonstrated disparities in health care access related to sociodemographic and economic factors, recent work has focused on geographic factors—leading a variety of authors to opine that one’s ZIP code may be a more important determinant in one’s health than one’s genetic code,” wrote co-author J. David Prologo, MD, of the Emory University School of Medicine in Atlanta, and colleagues.

The researchers sought to determine the status of IR staffing, recruitment and retention in the United States within small hospitals and rural communities. They issued a 22-question survey via email to American College of Radiology (ACR) members who identified as being a group practice leader, a general radiologist, an interventional radiologist or an abdominal radiologist.

Hospitals that served populations of up to 249,999 were defined as being rural hospitals and those who served 250,000 or more were designated as nonrural hospitals.

Overall, the researchers found there were “significant differences” in the ability of smaller and rural radiology departments and practices to recruit, retain and meet the demand for IR services.

Of the 1,005 survey respondents, 29 percent of rural hospital respondents, compared to 14 percent of nonrural hospital respondents, felt their group “falls short” or is “far short” of “meeting the demand for IR services.”

“Compared with their nonrural counterparts, smaller and rural radiology practices experience more difficulty meeting local demand for interventional radiology services, both at the hospital level as well as the regional hospital catchment area,” the researchers wrote.

A total of 67 percent of rural hospital respondents noted difficulty in IR provider recruitment, compared to 41 percent of nonrural hospital respondents. Also, 40 percent of rural hospital respondents, compared to 29 percent said they had difficulty in retaining an IR provider workforce.

The researchers also queried the respondents on why it was difficult to recruit IR providers. They found 56 percent did not want to provide diagnostic services and 49 percent do not want to practice in smaller, rural areas. Additionally, 68 percent of rural hospital respondents noted difficulty in retaining IR physicians because of the perception that there was an inadequate complexity of cases, and 66 percent of rural hospital respondents noted the number of cases as being a factor.

“The inability to provide adequate IR services may be a contributor to hospital and referrer dissatisfaction, as well as to patient care underperformance in rural and small areas—a situation that is likely to worsen amidst superimposed training pathway changes, health care system consolidations, and projected physician shortages,” Prologo and colleagues wrote.

Solutions to combat the problem suggested by the authors included managing the expectations for residents, developing training opportunities for general radiologists so they can perform less complex interventional procedures, contractual options for IR providers to practice in rural areas and aligning with other subspecialties and institutions.

The authors concluded that professional groups like the ACR and the Society of Interventional Radiology will likely have to play a role in developing plans to guide radiology practices.