Subspecialization may be growing in radiology, but generalists are still responsible for the majority of invasive procedures performed by radiologists, according to new research published in Radiology.
“Radiologist subspecialization has been recognized to contribute to disparities in patient access to radiologic services,” wrote lead author Andrew B. Rosenkrantz, MD, MPA, of the department of radiology at NYU Langone Medical Center in New York City, and colleagues. “However, the effect of the evolution of radiology subspecialization in general and of interventional radiology in particular on access to invasive radiologic procedures has not been well investigated.”
The authors studied CMS data from 2015, comparing procedures performed by generalists and subspecialists. The final study cohort included more than 1.5 million billed services performed by more than 12,000 different radiologists. Radiologists were classified as being generalists or subspecialists based on work-relative value units (wRVUs) associated with their billed Medicare claims.
Overall, 57.5 percent of the radiologists who performed common invasive procedures were generalists, more than 15 percent were interventionalists and more than 26 percent were noninterventional subspecialists. Thirteen of the 25 most common invasive procedures were performed most frequently by generalists.
In addition, generalists performed more than 46 percent of low-complexity procedures, more than 30 percent of mid-complexity procedures and more than 23 percent of high-complexity procedures.
“Despite the ongoing evolution of interventional radiology as a distinct specialty separate from diagnostic radiology and the increasing subspecialization of radiology more broadly, we found an important and ongoing role for generalists in meeting the procedural needs of radiology practices and their patients throughout the country,” the authors wrote.
Rosenkrantz and colleagues also noted that many more counties throughout the United States had local access to a generalist who performed procedures rather than an interventionalist or noninterventional subspecialist.
“This is a relevant observation, given our society’s increasing commitment to minimizing patient access disparities,” the authors wrote. “This observation is also notable given that the number of counties (n = 882) with at least one local radiologist performing invasive procedures was far less than the previously reported number of counties with at least one local radiologist (n = 1146), indicating that many radiologists are not offering any procedures at all. Thus, our findings challenge growing perceptions that the practice of radiology has become increasingly compartmentalized, with interventionalists now the physicians who are largely responsible for most image-guided procedures.”
These findings also show that generalists must “maintain their skills to perform at least basic invasive procedures,” the authors added. In many areas, a generalist will be a patient’s only option when it comes to receiving the care they need.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.