Overloaded radiologists are grappling with solutions to a booming volume crisis.
As with any industry, healthcare continually faces supply-and-demand challenges. In radiology, the once seemingly distant crisis of a strained workforce coupled with a growing demand for imaging services is now reaching critical mass. Finding solutions will require a shift in practice and thinking around innovative approaches to efficiency — positive disruptors that will shape radiologists’ role in providing uncompromised patient care. The first in a series on the radiology workforce and rising volumes looks at current and near-term challenges to existing delivery models and feasible strategies to mitigate negative outcomes.
If numbers never lie, radiology is facing a harsh truth. There is no sugar-coating the severity of the situation — it is time for the specialty to put its collective heads together to stave off the direst future scenarios. Finding new efficiencies within radiology groups and embracing new and existing technologies may hold the key to solidifying the cornerstone of healthcare services in the coming decades.
An aging Baby Boomer population, imaging overutilization, an increase in insured patients and the changing makeup of many radiology groups are the main drivers of workplace overload that threaten high-quality, accessible care. Other significant factors exacerbating the volume-versus-capacity conundrum include an overreliance on imaging by non-radiologist providers, expanded capabilities of diagnostic imaging that make it ubiquitous in healthcare visits, evolving ideals around job satisfaction, changes involving hiring practices and employee retention, fewer training opportunities, largely stagnant residency slots, and unbending attitudes around workplace culture.
Teleradiology and working from home have become an integral component of radiology departments and are unlikely to go away in the future. Advantages include decreased stress, increased work-life balance and increased feelings of autonomy. Potential disadvantages may be less visibility of radiologists to referring physicians and hospital administrators, diminished workplace engagement and negative effects on education and mentorships.
A large majority of practices allow some telework, and a large majority of radiologists currently telework or would like to in the future. “Some people associate telework with radiologists losing our connection with people, and we need to address that,” Rubin says. “Telework and teleradiology are not going away, so we have to start thinking of ways to improve upon what we have now.”
Current housing markets and costs mean people aren’t moving for new jobs when they can do their work from anywhere. Telework is only going to become more popular because it increases the ability to choose to do the things that are becoming the norm within society and culture, Rubin says. “I just don’t see us going back to a time where people will uproot and move for an on-site job,” he notes.
As radiology adapts to use everything in the toolbox, AI has the most potential to improve efficiencies in managing imaging volume within the strained workforce. “AI is not where it is going to be, but at some point it will get there,” says Dominick Parris, senior environmental intelligence analyst for the ACR.
“We don’t know the timeline, but radiologists who are AI-enabled now say it will be the most impactful on their workflows,” Parris says. “It won’t be interpretive AI right away, but rather AI tools that help radiologists focus on what they should be doing.”
New ACR research due to be released soon shows nearly half of practices are now using some form of AI, and at least three in 10 have been using it for the last five years, Parris says. No one should assume, however, that AI has been or will be a silver bullet. “In terms of impact, we wouldn’t be talking about a physician shortage if AI was having a great impact on the problem,” Parris notes.
It will be interesting to see how AI is incorporated on a large scale, Chertoff says. “When it comes to AI, people need to be behind the wheel,” she says. “That is key to AI delivering what we expect. And we have to change our perspective — not necessarily just looking at what AI is good at, but how AI tools can meet individual practice needs.”
AI algorithms need to be constantly monitored and retrained. “You can’t just walk away and assume everything will be fine because it never is,” Chertoff says. “We have to upgrade equipment and tweak protocols regularly, and AI is no different.”
AI may help with connectivity issues. That is, it could bring together multiple platforms radiologists work from to make the process seamless. “When I was working every day, I had a minimum of two screens open along with doing administrative work,” Chertoff says. “There are a lot of clicks happening between studies and prior reports and clinical issues that may need clarity. Having things connect quickly and properly would get the pebbles out of your shoes that can annoy you all day.”
Too often with innovation, it becomes about what keeps physicians comfortable in what they do, Chertoff believes. “Using AI could flip that to making things easier for others. We can translate reports that are tailored to the person receiving it — be that a patient or a referrer — so they are getting only the information they want and need,” she says. “We could really demonstrate our value that way.”
“Even when AI is in use in 100% of practices, it still won’t solve volume problems. It can help with efficiency, but not lessening volume,” Parris says. “And if we hope to stay ahead of future threats to the specialty in the next 10 years, IT and security will also need to drastically improve.”
Unfortunately, radiology is one of the most susceptible areas of medicine because of its reliance on electronic data and image sharing. Much like the workforce crisis, it can be difficult to persuade leaders to address AI now when daily workloads take precedence.
“I think there is definitely potential for AI to help groups gain some efficiencies,” Seidel says. “Our department is using AI to prioritize exams with potentially critical findings.”
Some sort of AI for smart scheduling for mammography is on Seidel’s wish list. “I think it is a challenging task because you never know how long a patient will be there — some cases are very quick and some patients end up being there for hours. It would be nice if there were a tool that could predict how long an appointment will take based on the patient’s reason for exam and prior images,” she says.
AI likely cannot help everyone. “It is not a great help for groups or practices where you must physically have people on the ground,” Rubin says. “That could be interventional radiology or fluoroscopy or anything we do that requires hands on patients. I’m not sure how AI is going to solve that.”
Where this is most problematic is not in urban areas or for practices operating out of urban-based centers, Rubin says. “It is extremely challenging in rural areas where we always have a shortage of radiologists.” Now more than ever, radiologists and other healthcare workers are urgently needed to preserve access to rural health facilities for communities that tend to be poorer, older and have more comorbidities.
“We can’t assume that practices and radiology groups have the luxury of resources to do more than they are already doing. What we are looking at is a crisis,” Chertoff says. “It’s not just about working smarter, because we already work smart. We need to revitalize, to renew ourselves. There are many things we can do, but what we must not do is just stick our finger in the dike. We have to grow and innovate — to provide high-quality care without standing still.”
There are some things in medicine in general that are moving in the right direction in terms of easing physicians’ time burden, Chertoff says. “You don’t need your doctor to prescribe vaccinations now, for instance. And for things like colonoscopy, why would you need a referral to get one when the primary indication is being age 50? There are more and more healthcare services you can access without physically showing up in the doctor’s office, and this saves time for physicians and patients alike.”
“My prognosis for the workforce and volume crisis would have to be kind of guarded,” Chertoff says. “We know we are going to hit this shortage, and we do not have a lot of time for our smart people to come up with some innovative changes that will renew us as a profession. If we don’t burn them out and drive them out before they can put changes in play, that does give me hope.”
Rubin also sees promise in the way things are headed for radiology. “I believe in the collective intelligence of the ACR and our members,” he says. “I also believe you should never assume you are the smartest person in the room. If you do, you will not be listening to the person who has something important to say.”
Rubin says his goal at the annual meeting is not to tell people what they should be doing, but to listen and then share with them some potential solutions that are now being considered. “I want to know what our members think the College, in collaboration with our other stakeholders, should be concentrating on to make those solutions viable,” Rubin says.
“We should be catching waves as they are building toward the shore, not when they crest and hit us with whitewater,” Rubin says. “We can’t tell groups what to do with their businesses, but we can be there to assist in making them more successful.”
We would love to hear what you think about the article. If you have questions or comments — or would like to share your own experience with workforce challenges — please send them to chudnall@acr.org. And don’t forget to explore new ACR Bulletin content each month, including more coverage of the workforce vs. capacity crisis, to stay current on the most important topics in radiology.
Finding Solutions at the ACR Annual Q&S + Informatics (QS+I) Conference
The ACR Annual Conference on Quality and Safety + Informatics left attendees feeling optimistic about the future as they found actionable solutions to challenges facing the specialty.
Read more
The Domino Effect: Improving PFML in Radiology
Solving the paid family and medical leave issue within the specialty will help radiologists avoid burnout and alleviate the workforce shortage issue.
Read more
The Economics and Strategic Deployment of AI in Radiology
ACR takes a big step toward educating and guiding the specialty in evaluating AI tools â with patient safety and reimbursement in mind.
Read more
