Dwindling number of generalists in radiology could have ‘far-reaching implications’

The number of generalists in radiology is shrinking as the field becomes more hyper-specialized, a trend that warrants attention from imaging leaders, with it potentially hindering patient access.

Overall, the number of generalists in radiology dipped by about 7.6% in the five-year period ending in 2017, according to a new analysis, published Dec. 31 in the Journal of the American College of Radiology. At the same time, the proportion of subspecialists swung upward 7.6%, including notable gains in breast and abdominal imaging.  

With demands for 24/7 imaging services, robust access in rural areas and an emphasis on efficiency all increasing in medicine, radiologists must keep a keen eye on this development.

“Ongoing shifts in the relative balance between generalists and subspecialists is a topic of considerable importance within the radiology community, as such shifts could have far-reaching implications,” wrote Andrew Rosenkrantz, MD, with the Department of Radiology at NYU Langone Health, and colleagues. If it continues, they added, this shift could have a profound effect on everything from training programs to certification processes, hiring patterns, practice management, quality metrics and specialty society strategic planning.

Rosenkrantz and colleagues derived their conclusions from fee-for-service Medicare provider payment data, gathered between 2012 and 2017. Radiologists were labeled as subspecialists when their work in a specific specialty exceeded 50%, and generalists when it fell below that threshold.

The proportion of subspecialists rose from about 37% in 2012, up to almost 45% by the end of the study period, investigators found. Generalists' numbers, meanwhile, sagged from about 63% at the start, down to about 55% by 2017. The authors noted particular gains in specialties such as breast (up about 4%), abdominal (2%), neuroradiology (2%) and musculoskeletal care (1%). Interventional radiology, however, saw a more than 1% dip in its numbers, the analysis discovered.

Rosenkrantz et al. also found that subspecialization increased markedly among female radiologists (up 12% during the study period), early career professionals (10%) and those in larger practices with greater than 100 members (7%). All told, the swing away from general radiology was seen in 45 U.S. states.

The analysis did not pinpoint drivers of this shift toward specialization, nor how it impacted patient outcomes—both areas for further exploration. And Rosenkratz and colleagues did not determine whether this development is good or bad for the specialty as a whole, with positives to be found on both sides. Fragmentation is also a growing concern when radiologists splinter into increasingly specialized practices.

“Although growing subspecialization may advance more sophisticated imaging care, a diminishing supply of generalists could affect patient access and potentially separate radiologists across workforce sectors,” the team concluded.

For more on this topic, you can also read our feature story from the latest issue of Radiology Business Journal: “How Will the Generalist Survive?”