ACR Bulletin

Covering topics relevant to the practice of radiology

The Radiology Labor Shortage

The College is committed to optimizing our workforce as we continue to bring vital and innovative medical care to our patients.
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Due to a variety of factors — some unique to our profession — practices are feeling the pressure to provide more services, while battling a lack of staff to accommodate the demands.

February 10, 2022

 In any industry, the ability to deliver goods and services is dependent on its workforce. Especially during the ongoing COVID-19 pandemic, workforce issues have been front and center — with employee shortages impacting service industries particularly hard.1

Radiology has not been immune to these shortages. Due to a variety of factors — some unique to our profession — practices are feeling the pressure to provide more services while battling a lack of staff to accommodate the demands.

Multiple sources have projected that the demand for medical imaging will continue to rise. In 2018, research and consulting firm Frost & Sullivan looked at utilization controls versus the growing Medicare population, which tends to have higher rates of medical imaging. They predicted that, at least in the intermediate term, the demand for services would continue to grow.2 Other sources documented the temporary decrease in services during the initial COVID-19 peak with a rapid bounce back after restrictions were lifted.3

The demographics of our workforce need to be considered when looking at future needs. The current radiologist population is skewed toward seasoned professionals who may be looking at retirement. Of the 20,970 radiologists engaged in active patient care, 82% are age 45 and over, while 53% are age 55 and over.4

Our practices and departments have been dealing with the issue of radiologist burnout for several years. Much has been researched and publicized about its impact. 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. Increasing rates of burnout have been reported over several years.5 A 2020 Journal of Breast Imaging study found a high prevalence of burnout among breast imagers, particularly early-career professionals.6

The ACR has developed resources through its Radiology Well-Being Program to address the problem of burnout in the profession. Members of the ACR’s Well-Being Committee have created tools for individual radiologists as well as case studies for health system leaders who must change the systemic issues that can contribute to burnout (learn more in the Feb. 2021 Imaging 3.0® In Practice).

Many practices have turned to alternative staffing models, including non-physician radiology providers (NPRPs) such as nurse practitioners, physician assistants, and registered radiologist assistants. While these NPRPs provide vital functions, the use of physician extenders has become very controversial within the College’s membership. Many concerns have been voiced about the quality of the services they provide and the potential for radiologist job displacement. The national organizations that advocate on behalf of the nurse practitioners have been aggressively lobbying for independent practice. The American Academy of Physician Assistants is looking to change physician assistants’ titles to “associates.” The ACR is aggressively addressing scope of practice (SOP) challenges with its SOP fund and is looking at the feasibility of developing radiology-specific SOP guidelines.

Another tactic has been to turn to teleradiology. Originally, the term teleradiology was most frequently identified with outsourcing evening/night work. More practices are now “internalizing” teleradiology for employees, partners, and faculty — the radiology equivalent of working from home. Although abandoning on-site presence certainly risks commoditization, utilizing teleradiology as a supplement to help decompress volume is an effective recruiting tool.7

At our Fall 2021 BOC meeting, Immediate Past Vice President of the ACR and Immediate Past President of the Society of Chairs of Academic Radiology, Alexander M. Norbash, MD, MS, FACR, presented data concerning the growing recognition of RT shortages. In a recent SCARD/Association of Administrators in Academic Radiology survey, only 6% of respondents believed that the current RT workforce was sufficient in size for recruitment purposes. The survey also found that 53% of training programs for radiology, radiation therapy, and nuclear medicine programs are at full enrollment.8 RTs are becoming a rate-limiting factor for many of our practices. In discussions with our allied health partner societies, some contributing factors include wages, concerns about safety during the pandemic, limited advancement opportunities, and a lack of respect and support compared with nurses and other healthcare workers. Clearly, we can and should do more to help support our valued allied health colleagues.

Early on, some suggested that AI would replace radiologists. Now, most experts agree that while AI might supplement radiologist workflow, there is the stronger probability that additional AI-based capabilities will expand the role of medical imaging and radiologists and may in fact add to our workload demands.9

Recently, legislation increased the number of government-supported medical residency slots by 1,000.10 As of now, there is no prediction on how many of these slots may be designated to radiology. Even if radiology slots are considered, the number would unlikely be adequate to address our projected needs. We may need to prepare a future legislative effort to specifically expand radiology training positions or develop alternative approaches.

Radiology is a strong profession with optimistic projections of our future. Yet, similar to many service industries, we are experiencing workforce challenges as demands for our services continue to grow. Continued growth is opportunity and together we will find solutions to the workforce challenges. By raising awareness, the ACR is committed to working with our members, practices, and other organizations to optimize our workforce as we continue to bring vital and innovative medical care to our patients.


1. Wittenberg-Cox A. “Is The ‘Great Resignation’ Actually A Mass Retirement?” Forbes. Nov. 16, 2021.
2. The Future of the United States Medical Imaging Industry. Frost and Sullivan. Jan. 16, 2018.
3. Walter M. “ED imaging demand skyrocketed in 2021, and many radiology providers are struggling to keep up. What's next for the specialty?” Medical Imaging Review. 2021.
4-5. Montecalvo R. Radiologist Staffing Trends 2021. V Rad. Feb. 18, 2021.
6. Parikh JR, Sun J, Mainiero MB. Prevalence of Burnout in Breast Imaging Radiologists. Journal of Breast Imaging. 2020; 2(2):112–118.
7-8. Enrollment Snapshot of Radiography, Radiation Therapy, and Nuclear Medicine Technology Programs ─ 2020. ASRT. January 2021.
9. Davenport TH and Dreyer KJ. AI Will Change Radiology, but It Won’t Replace Radiologists. Harvard Business Review. March 27, 2018.
10. Congress Passes Historic GME Expansion. AAMC. Dec. 23, 2020.

Author Howard B. Fleishon, MD, MMM, FACR  Chair of the Board of Chancellors