All signs indicate that the radiology job market is turning around. The number of available positions in 2016 well exceeded the number of finishing trainees, and this trend is expected to continue as more senior radiologists retire or cut back. A 2013 Health Affairs study projected that as the U.S. population ages, demand for radiology services will grow approximately 18 percent between 2013 and 2025 (Health Aff (Millwood). 2013 Nov;32(11):2013-20). When accounting for other factors leading to an overall increased utilization of radiology services, the increase in volume will likely be larger. Compounding this numbers problem, a higher proportion of radiologists are interested in limiting the number of hours they spend at work. So along with the other challenges facing the field, radiology is now in the position of facing a shortage of physicians.
In 2015, applications for radiology residency were the lowest in a decade, according to data from the National Resident Matching Program. Conversations with medical students yield concerns about declining reimbursement and uncertainty about the future of the field. However, this factor only accounts for a fraction of their concerns. Compensation cuts and rapidly evolving practice landscapes are realities across the board in medicine, and radiology remains one of the better reimbursed fields. So what is it about radiology that’s causing a decline in applicants?
Digging deeper, a less discussed factor provides some answers. Medical students have been listening to the complaints of those they rotate with. As an increasing percentage of women and millennial physicians enter the job market, simply looking at compensation downplays the crucial role that work-life balance and job satisfaction play in selecting a specialty. Millennials have consistently shown that they are willing to take significant salary cuts to achieve better work-life balance. For women, who stereotypically place more emphasis on this, the numbers indicate that radiology is not faring well with recruitment. Although nearly 50 percent of medical students are female, only approximately 27 percent of radiology residents are female.1
According to a recent study published in Mayo Clinic Proceedings, radiologists ranked fifth out of more than 23 surveyed specialties in their reported burnout rate (Mayo Clin Proc. 2015 Dec;90(12):1600-13). While 47.7 percent of radiologists reported experiencing burnout in 2011, that number jumped to 61.4 percent in 2014. Contributing factors include increasing volumes, the heavy emphasis on reducing turnaround times, decreasing reimbursement and the amount of required after-hours work. Also, as radiology groups look to compensate for lost income by taking back the night from teleradiology, companies and hospitals are increasingly requesting in-house (and in some cases, subspecialty) coverage and the frequency of in-house calls has become more burdensome. It’s been cited as a reason why many switch to teleradiology jobs, as well as a reason why competitive medical students choose to pursue other in-demand specialties, which for the most part allow calls to be taken from home and utilize physician extenders to cover basic needs in the hospital. While medical students are expressing a preference for lifestyle-oriented fields, the average radiology group is actually shifting in the other direction.
Traditionally, radiology practices have operated on an egalitarian model, with work responsibilities, income, and vacation being evenly distributed amongst partners. There are obvious benefits to this framework, and its simple nature is appealing to groups that don’t want to get caught up in the many nuances that arise if they stray from it. Accommodating part-time physicians can significantly complicate work and vacation scheduling, for example. And employing part-time physicians can contribute to the mentality that shifts extra responsibility onto full-time partners, adding to an already perpetually increasing administrative burden. Structuring partnership agreements to reflect varying commitments to the practice while still remaining fair to everyone involved can become very subjective, and often contentious.
Regardless, it is now time for a change. Although many groups would (understandably) make the argument that they are looking to recruit people who are willing to work more, rather than less, these radiologists are in limited supply. Recruitment and retention of full time radiologists with large call responsibilities will become increasingly difficult as the demographics of trainees change. The lack of part-time options or flexibility in scheduling is one of the most common cited factors in the decision of a growing number of radiologists to shift to locums or teleradiology positions. As this trend is often blamed for undermining the private practice radiology group’s ability to negotiate with hospitals, commoditizing radiologist skills and driving down reimbursement, groups should pay close attention to this new demographic.
We as a field need to become more creative and address changing demographics and physician burnout. We need to make it possible for people to work varying amounts and recognize the needs of those who would trade a portion of their compensation for increased flexibility. As groups grow larger, the potential for these opportunities should increase. This would help groups with the recruitment of new physicians while also helping them keep senior partners who might be looking to scale back a bit.
Time off is an obvious area that groups should revisit. Most radiology groups offer generous amounts of vacation, but also tend to offer vacation in one-week blocks to ease scheduling complexity. This process is problematic for those hoping to take more three day weekends or have an occasional day off to go to a school event. By offering at least a portion as individual days off, radiologists could choose to work less days a week, and part-time positions could be more easily accommodated.
Job sharing doesn’t have to only involve two people; it could be a combination of three or four people who make up an even number of full time equivalents. Tailoring worklists such that certain assignments could be handled remotely would also allow for greater options in larger groups, including an expanding role for home workstations and the ability to customize work hours. The utilization of physician assistants can provide additional latitude. Many groups have found “weighing” shifts to be helpful, heavily incentivizing those who are willing to work nights, weekends and holidays. Those who don’t want to take as much call should be permitted to outsource their calls to other radiologists in the group or even locum radiologists.
Groups in the Midwest and the South will have to adjust first, as this is where the largest percentage of open positions are right now. These groups have conventionally attracted fewer applicants, but have been able to successfully recruit by offering higher salaries and lower costs of living. Given that millennials are less lured by these factors, recruitment will become increasingly
difficult. This will be compounded by the fact that many of these groups are smaller and may need radiologists who are willing to be generalists. Today’s trainees, who are completing mini-fellowships in residency followed by formal fellowships after residency, may find themselves uncomfortable with these positions. Having more flexible options than those offered by in-demand urban groups would provide these groups with a competitive edge.
Lastly, more groups may want to consider providing paid maternity leave. In the larger scheme of a radiologist’s career, paying for a few months of time off is likely a drop in the bucket. However, for young female radiologists coming out of training, who are often burdened with medical school debt, this unpaid time can be quite stressful. The prospect of paid maternity leave not only relieves that stress, but fosters goodwill in showing that a group is family friendly. This trait can be incredibly important to women physicians, and may be the reason why they pick one job over the other.
Market forces will ultimately force radiology groups to adapt, despite the hassles that come along with shifting away from traditional models. Happy radiologists are good for business, and maintaining the competitiveness of radiology applicants is good for the field. The evolution of our group practice models is consequently not only necessary, but smart.