No One Thing

Historically, radiology workforce dynamics have been cyclical, with volume and staff levels rising and falling related to new technologies, aging patients and physicians, regulatory hurdles and interest in the specialty, as well as retention. What’s happening now within the workforce space is different. You can’t wait this one out — your health, the safety of your patients and the solvency of your practice may be at great risk.

Radiology groups and practices of all types have been scrambling to find both short- and long-term solutions, with limited success. The current workforce climate lends itself to some daunting truths, including accelerating consolidation, burnout, retention challenges, quality and safety concerns and a lot of head scratching around how to implement tailored artificial-intelligence (AI) solutions to save the day.

The Bulletin spoke with Eric M. Rubin, MD, FACR, chair of the ACR Commission on Human Resources, about what ACR is doing to mitigate workforce challenges for all radiology groups and practices — and this work centers on listening to what members are saying they need to survive and, eventually, thrive.

Where do you think ACR’s focus should be in the current workforce climate?

ACR, at its heart, is finding ways to talk about how we are more similar than different. We need to hear people’s stories, and we need to know what they need from us. Tell us: What is good about the practice type you are in? What are the challenges? We are not here to point fingers at each other and say somebody else’s practice type is bad. We need to understand how everyone’s practice type is being impacted and how that affects their ability to impact operational and financial decisions and, by extension, to take care of patients. Workforce struggles are likely to affect everyone in radiology in one form or another — and to present problems for practices and patients.

Is hiring more radiologists the best way to mitigate workforce challenges?

Increasing the number of workers is only one potential solution to the problem. We could rely on the cyclical nature of our workforce to get through this, but will that cycle continue as it has in the past? The answer is probably yes, but what we don’t know is what factors will affect the cycle. My guess is that one of those factors won’t be adding more radiologists rapidly or homing in on increased reimbursement — and I think that’s very important for medical professionals to understand.

How does private equity and consolidation play into the workforce conundrum?

Radiologists see the market shifting to a consolidated space. That will continue to happen. I try to move people away from the idea that private equity or the corporate ownership of radiology practices is at the heart of the problem. In truth, private equity as it relates to radiology practices is just another potential solution to the workforce shortage. In other words, we are seeing consolidation within the radiology space because consolidation gives you economies of scale with respect to concentrating your workforce. It pulls together financial resources in a manner that allows you to deal with the overhead that is crushing some groups in a declining reimbursement environment. If you run an imaging center, for example, that equipment is expensive. The PACS is expensive. I know of a radiology group that sold out to private equity due to unmanageable IT infrastructure expenses.

How might AI help and what can the College do to accelerate impactful AI implementation?

A lot of focus at the moment is on interpretive AI. The ACR Data Science Institute®, for example, has introduced ARCH-AI, which sets guidelines for imaging interpretation. Radiology groups need some sort of playbook on what it takes to implement AI in their practice. An implementation plan for any health system needs to be very deliberate. Ideally, you’d have multispecialty oversight committees allowing people to collaboratively discuss and understand the algorithms and their impact on overall patient care.

Is more interest in subspecialties impacting the output of some practices?

I don’t think I’ve ever met a radiologist excited to work at the bottom of their license. Interest in your subspecialty is vital to excellence in radiology. That said, will everyone get to practice inside their subspecialty all the time in every practice type? Obviously not. The needs of a practice will dictate that, and those practices that can recruit and retain talent who are willing to help meet those needs will succeed.

Will the growing need for physician extenders slow legislative efforts on scope of practice?

As I mentioned earlier, the volume crisis won’t be ameliorated by any single solution, and some will have greater short- and long-term impacts than others. We expect that the practices who succeed will employ multiple mitigation strategies, depending on their relative resource level. I don’t know if anyone can predict the future legislatively, but I do know ACR will work hard to have radiologists’ voices heard on all issues facing the specialty, including scope of practice.

What can be done to encourage medical students to choose radiology when deciding to pursue the specialty?

We’re seeing practices really extending themselves in an effort to provide work-life balance, part-time opportunities and the option to work from home (if that is realistic based on clinical duties). If you ask me, radiology is more inviting than ever from the perspective of a job seeker. In a paper I coauthored, we also made the point that, in the long-term, graduate medical education expansion to bolster the pipeline to radiologist trainees is imperative to handle the needs of the aging population.

Interview by Chad Hudnall, senior writer, ACR Press