Category: Radiologists

Forecasting Radiologist Supply

Posted on by Brian Casey

Two new studies published this week in JACR raise the provocative question: Will there be a radiologist shortage in the future given growing demand for medical imaging services?

It’s a question that’s become commonplace across healthcare as burnout and other issues prompt many physicians to leave the field. 

  • This has caused workforce shortages that raise questions about whether the U.S. – and other advanced economies – will be able to meet growing demand for healthcare services by an aging population.

The new studies were conducted by Harvey L. Neiman Health Policy Institute researchers and each tackles one aspect of the supply/demand equation over the next 30 years. 

The first study analyzed past growth in the radiologist workforce to find …

  • There were 37.5k radiologists enrolled to provide care to Medicare patients in 2023. 
  • With no growth in the number of residency positions, there will be 47.1k radiologists in 2055, an increase of 26%.
  • If residency positions grow, there will be 52.6k radiologists, an increase of 40%.

The wildcard here is growth in residency positions, which are mostly controlled by Medicare through its graduate medical education program – and it literally takes an act of Congress to increase the number of trainee positions. 

  • Another factor is whether the higher physician attrition rate seen during the COVID-19 pandemic continues into the future. 

The second study addressed growth in imaging volume by analyzing trends in claims data for Medicare, Medicaid, and private insurance, finding …

  • Imaging utilization will be 17-27% higher by modality by 2055 assuming no continuation of recent utilization trends.
  • Most utilization growth will be seen in nuclear medicine (27%), CT (25%), interventional radiology (23%), X-ray (18%), and MRI and ultrasound (17% each).
  • Adding recent utilization trends to the model finds utilization by 2055 either -5.6% lower or up by 45%.

Factors affecting future utilization include population growth (73-88% of increase) and population aging (12-27%). 

The Takeaway

So will there be a radiologist shortage in the future? The new studies indicate that there are too many variables to make an accurate prediction right now. But they do provide a foundation for future research – and debate. 

Top Radiology Trends for 2025

Posted on by Brian Casey

There’s no question that 2025 will be a watershed year for radiology. AI is on the cusp of going mainstream, the radiologist shortage won’t go away, and a number of new U.S. regulatory initiatives promise to reshape the field. 

As we did in 2024, The Imaging Wire asked key opinion leaders in medical imaging to provide their predictions on the technologies, clinical applications, and regulatory developments that will shape the specialty for the next 12 months.

AI Blurs Lines with Generative Models: “Providers will interchangeably use both general-purpose and custom-built GenAI models for regulated (e.g., draft reporting) and unregulated (e.g., EHR summaries) tasks. This will blur current lines for medical device determination, shift performance testing from regulators to providers, and encourage regulators to define comprehensive clearance pathways for GenAI.” – Keith Dreyer, DO, PhD, and Bernardo Bizzo, MD, PhD, Mass General Brigham/Harvard Medical School

AI Focus on Reporting and Synthetic Data: “There will be continued interest in using generative AI for reporting and synthetic data alongside ongoing discussions about bias, fairness, and regulations. We can expect an increasing focus on automated draft report generation. I look forward to seeing the community explore radiology use cases for test-time compute and agentic AI.” Woojin Kim, MD, CMIO, Rad AI

Breast Density Reporting Now in Effect: “The FDA ‘dense breast’ reporting standard is now in effect; needed next is standardization of insurance coverage. Individual state insurance laws are inconsistent, and while a federal Find It Early Act did not pass in 2024, supporters will likely reintroduce the legislation in 2025 to ensure health plans cover screening/diagnostic breast imaging with no out-of-pocket costs for women with dense breasts or at higher risk for breast cancer.” – JoAnn Pushkin, executive director, DenseBreast-info

Breast Screening Based on Risk: “The future direction of breast screening will likely include AI to analyze mammograms and other screening imaging studies as well as patient health data rather than family history and lifestyle choices, allowing more accurate risk assessment. Patients will receive tailored screening recommendations, and imaging may include breast MRI, DBT with AI assistance, and other technologies to identify small high-grade aggressive tumors. Genetic testing results will help identify patients at high elevated risk, providing patients with accurate, clear information about their individual risk and engaging them with shared decision-making regarding benefits and harms of screening opportunities.” – Stamatia Destounis, MD, managing partner, Elizabeth Wende Breast Care 

MRI Safety Comes of Age: “2025 will be the year of MRI safety’s ‘coming of age.’ New CPT codes to reimburse providers for the additional effort required to ensure safe scanning of patients with implants are the first time a formal structure has been established to ensure at least some MRI safety. This CPT change isn’t a stand-alone revolution, but a bellwether of the ‘young adulthood’ of MRI safety and changes yet to come.” Tobias Gilk, founder, Gilk Radiology Consultants

New Era for CT Colonography: “A new era for CT colonography started on January 1, 2025, when CMS started coverage for colorectal cancer screening. Adding CTC as an option for CRC screening will ultimately save lives since it identifies precursor polyps as well as cancer. Expanding screening CTC to some of our most vulnerable patients – including African Americans, who have higher rates of colorectal cancer – will help to improve health disparities. Radiologists need to be prepared to handle increased CTC volumes to assure efficient and effective patient care.” – Judy Yee, MD, Montefiore Medical Center/Albert Einstein College of Medicine

Patients Discover AI for Medical Images: “Patients will use consumer-grade, multi-modal generative AI chatbots like ChatGPT to interpret their medical images and verify radiology reports for missed findings. Because they are not marketed for medical use, regulators will struggle to enforce oversight and could announce enforcement discretion for consumer use of these general-purpose AI models.” – Keith Dreyer, DO, PhD, and Bernardo Bizzo, MD, PhD, Mass General Brigham/Harvard Medical School

Radiologist Shortage Deepens:  “Maintaining proper staffing to support increasing volume will be the number one priority for private practices with hospital-based services in 2025. The shortage of radiologists is deepening, and with the demand for staffing growing so is the compensation package necessary to attract candidates. Private practices serving hospitals with weaker payor mix profiles will continue to seek financial support from their hospital partners to remain competitive in the market, not only to recruit new radiologists but also to retain current staff.” – Daniel Corbett, chief of business development, Radiology Business Solutions

Radiology in the Spotlight – for Better or Worse: “2025 will be the first year of Trump 2.0. Elon Musk and Vivek Ramaswamy will be busy beavering through the federal government. All attention will be on healthcare costs again. Radiology will be in the spotlight with calls to curb utilization, adopt AI, abolish fee-for-service, and adopt alternative payment models.” –  Saurabh Jha, MBBS, AKA RogueRad, Hospital of the University of Pennsylvania

Radiology’s Tough Economy Triggers Action: “I expect the global imaging market to look quite different at the end of 2025 versus the start, as tough economic conditions trigger action: M&A of small and mid-size hardware innovators; consolidation in imaging AI with category leaders emerging; the growing influence of non-imaging actors (pharma and life sciences, imaging service providers, big tech); price competition biting for the largest hardware vendors in emerging markets; and speculatively, at least one multi-billion top 20 vendor ‘mega-merger.’ Buckle up!” – Steve Holloway, CEO, Signify Research     

Regulation and Reimbursement: “Reimbursement decreases and recruitment challenges persist in 2025. While it remains critical that radiologists continue to advocate for the specialty and diversify their business plans, it’s becoming increasingly important for hospital-based groups to understand the fair market value of their services and potentially negotiate for additional support.” – Sandy Coffta, VP of client services, Healthcare Administrative Partners

Reimbursement Aids Nuclear Medicine Access: “In 2025, CMS reimbursement policy adjustments are expected to increase nuclear medicine usage and patient access. Ongoing clinical trials will likely drive approval of new radiopharmaceutical therapies and theranostics. With the radiopharmaceutical market projected to reach $12.4B, we expect improved access to nuclear medicine diagnostics and treatments in oncology, neurology, and cardiac imaging.” – Cathy Sue Cutler, PhD, SNMMI president and chair/Brookhaven National Laboratory

The Takeaway 

Making predictions is never easy, and that’s particularly true in a discipline as dynamic as radiology. Whatever happens in 2025, you’ll be sure to read all about it in The Imaging Wire. 

Radiologist Salaries Lag Inflation

Posted on by Brian Casey

A new study in JACR confirms what many radiologists have suspected: salary growth for private-practice radiologists has lagged inflation over the last 10 years. While there were a few bright spots, the study mostly shows that radiologists are working harder for less pay. 

Radiology has long been one of the better-compensated medical specialties, often landing in the top 10 of disciplines with the highest average annual compensation. 

  • But radiology has also been a target for reimbursement cuts by the U.S. government as it tries to shift more Medicare and Medicaid payments to primary care practitioners.

As a result, previous studies have found that payments per Medicare beneficiary in radiology have actually declined. 

  • And another 2.83% cut is on the docket for 2025 unless Congress steps in before the end of the current legislative session to prevent cuts in the 2025 Medicare Physician Fee Schedule.

The new study analyzes radiologist compensation based on MGMA salary survey data from 2014 to 2023. 

  • Researchers compared salaries for both diagnostic and interventional radiologists, and also between private-practice and academic radiologists. 

Based on the data, they found …

  • Diagnostic radiologists saw median total compensation grow over the survey period, but at a faster rate for academic radiologists (32% vs. 18%). 
  • Academic radiologists enjoyed faster annualized salary growth (3.2% vs. 1.9%) and had an edge after adjustment for inflation (+0.3% vs. -1%).
  • Work RVUs (a measure of productivity) also grew but at a slightly higher rate for academic radiologists (21% vs. 20%). 
  • Interventional radiologists saw higher salary growth for both non-academic and academic physicians (41% and 35%). 

The findings indicate that the traditional salary gap between private-practice and academic radiologists may be narrowing.

  • The growth in wRVUs in a time of stagnant or declining salaries after inflation adjustment may confirm the suspicions of both types of radiologists: that they are working harder for less pay. 

The Takeaway

The findings could be a gut punch for private-practice diagnostic radiologists, who are finding that their salary gains aren’t keeping pace with inflation (sound familiar?). They also suggest that academic radiology could offer a refuge from the market and government forces that are reshaping the private sector.

Radiologist Shortage Looms

Posted on by Brian Casey

A new report from healthcare staffing firm Medicus Healthcare Solutions paints a gloomy picture of the demographic crush facing radiology as the US population ages and imaging volumes rise, but the number of radiologists remains static. 

Radiology’s demographic dilemma isn’t new to anyone in the field. Radiologists are having to work harder to meet growing demand for imaging by an aging population, while reimbursement falls.

  • Meanwhile, efforts to grow the number of radiologists are hamstrung by the country’s physician training system, which requires a literal act of Congress in order to expand the number of residency slots. 

The new Medicus report mostly draws on established data sources, but it provides insight into the supply and demand challenges facing radiology, presented in an attractive graphical format. Salient points include …

  • There are about 37.7k diagnostic radiologists in the US, with job growth of 4% annually through 2032
  • Since 2020 there have been only 22 new diagnostic radiology residency PGY-1 positions added
  • From 2010 to 2020, the number of diagnostic radiology trainees grew 2.5%, while the number of US adults over 65 rose 34%
  • By 2030, all baby boomers will be aged 65 and older – and will require more medical care
  • The gap between radiology supply and demand is expected to grow through 2034 (see above chart)

What’s more, the vast majority of radiologists reaching retirement age are generalists, while the field’s recent focus on subspecialization means many younger radiologists aren’t comfortable reading scans outside their focus. 

The Medicus report isn’t all doom and gloom. It does offer some possible solutions to the staffing shortage, including teleradiology, AI, and increased use of locums tenens radiologist services (which Medicus provides). 

The Takeaway

The Medicus report provides a snapshot of a medical specialty that – like many others – is facing a demographic crunch between rising demand and fixed supply. Hopefully, technologies like AI will enable radiologists to do more with less in the years to come.

Radiology’s Private-Practice Squeeze

Posted on by Brian Casey

It’s no secret that US radiology’s traditional private-practice model has been slowly fading away, but new numbers published in AJR illustrate the magnitude of the shift. The number of radiologist-affiliated and radiologist-only practices has dropped, even as the total number of US radiologists has gone up. 

Radiology has long prided itself on a cozy business model in which radiologists banded together as owner-operators of small private-practice groups that contracted their services with hospitals. 

  • This model has had many benefits for radiologists, but it’s begun to fray in the face of competitive threats like teleradiology providers, health system consolidation, and large national radiology groups like Radiology Partners.

Many radiologists have chosen to switch rather than fight, selling out to national groups or taking positions as employees within health systems.

  • Meanwhile, some practices that want to stay independent are finding strength in numbers by joining with other like-minded groups or seeking out multi-specialty medical groups. 

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed CMS data from 2014 to 2023, tracking not only changes in the number of US radiologists but also their type of employment, finding …

  • The number of radiologists grew 17%, from 30.7k to 36k
  • But the number of radiologist-affiliated practices fell 15%, from 5.1k to 4.3k
  • The number of radiology-only practices fell 32%
  • The number of small radiology practices fell, with the decline varying by practice size: 1-2 radiologists -19%, 3-9 radiologists -34%, and 10-24 radiologists -25%
  • The number of large practices jumped, with the biggest increase – 349% – at very large practices (over 100 radiologists)
  • The mean number of radiologists per practice shot up 84%, from 9.7 to 17.9

Why the shift? The researchers theorized that much of it was driven by federal policy and reimbursement changes that incentivize consolidation, mostly to spread the risk and cost of compliance with various regulations like ACA and MACRA.

The Takeaway

There’s no question that radiology is changing – the question is what impact the changes will have on how radiologists perceive their work. The old guard may choose to rage against the dying of the light, while younger generations embrace the new model and its benefits for both professional careers and patient care. 

Radiologist Pay Rebounds

Posted on by Brian Casey

Radiologist pay grew 5.6% and radiology moved up one notch on Doximity’s list of highest-paid US medical specialties for 2023. Physician salaries generally rebounded last year after a decline in 2022.

The Doximity survey of 33k doctors found that overall physician pay grew 5.9% last year, a welcome rebound after a decline of 2.4% in 2022. 

  • In other good news, medicine’s gender pay gap narrowed in the new survey, with women making 23% less than men, down from 26% in 2022 and 28% in 2021.

For radiologists, their average annual compensation was $532k, up from $504k a year ago, and radiology jumped ahead of urology on the top 10 list to occupy the ninth spot. 

  • Still, radiology lagged a number of other specialties in terms of salary growth, ranging from hematology (+12.4%) to psychiatry (+7.2%). 

Other findings in the survey include …

  • Some 81% of physicians reported they are overworked, a number that’s actually down from 86% in 2022
  • 88% of respondents said their clinical practice has been affected by the physician shortage
  • 86% of those surveyed said they are concerned about the US healthcare system’s ability to care for its aging population

The Doximity results roughly track recently released salary data from Medscape, which pegged radiologist salaries at $498k in 2023, up 3.1% and ranking sixth on the list of highest-paid specialties. 

The Takeaway

Say what you want about rising workload and burnout in radiology – radiologists are still among the best-compensated physicians in medicine. And the situation in the US is in sharp contrast to Japan, where radiology is one of the lowest-paid specialties (see our article in The Wire section below).

Doctors Work Harder for Less

Posted on by Brian Casey

Medicare reimbursement to physicians per beneficiary has declined over the last 16 years, with radiologists among the biggest losers. That’s according to a new study by the ACR’s Harvey L. Neiman Health Policy Institute, which confirms what many physicians already knew: they are working harder for less money.

It’s no secret that the US government has been struggling to rein in healthcare costs for decades. 

CMS has a number of tools at its disposal for controlling Medicare and Medicaid costs, one of which is the relative value unit (RVU) scale. 

  • RVUs – when multiplied by monetary conversion factors – basically set the amount of money the agency pays physicians per unit of work, with CMS typically reducing the conversion factor when it needs to cut Medicare spending. 

In the new study in the journal Inquiry, Neiman HPI researchers analyzed trends in RVU and conversion factor levels per Medicare beneficiary from 2005 to 2021, analyzing changes to calculate how much work providers have to do to deliver a unit of care. Findings included …

  • Reimbursement per Medicare beneficiary after inflation adjustment fell 2.3% for physicians as a whole
  • Radiology saw one of the biggest declines in MPFS reimbursement per beneficiary, ranking 31st on a list of 39 medical specialties, with a 25% decrease
  • Reimbursement has risen 207% for non-physician practitioners

What’s driving the declines? The Neiman HPI researchers identified the federal government’s budget neutrality rules for Medicare, which stipulate that increases in one area have to be offset by declines elsewhere.

The Takeaway

The new findings confirm what many physicians have suspected – they are not only working harder for less, but non-physician practitioners seem to be getting a bigger piece of the pie. Combined with a recent report showing that radiologist salaries didn’t keep pace with inflation in 2023, it’s not a pretty picture. 

Radiologist Pay Grows 3%

Posted on by Brian Casey

Annual salaries for US radiologists grew 3.1% in 2023 in the most recent physician salary report by Medscape. Although radiologist salaries are nearing the half-million-dollar mark, the increase actually represents a slowdown compared to 11% growth last year. 

The Medscape report shows that US radiologists had an average annual salary of $498k in 2023, compared to $483k in 2023 and $437k in 2022.

  • Radiologists ranked sixth on a list of 29 medical specialties, with orthopedic physicians topping the charts at $558k and diabetes and endocrinology doctors at the bottom at $256k. 

The report surveyed 7k practicing US physicians from October 2023 to January 2024, finding … 

  • 61% of those surveyed thought physicians overall are underpaid
  • 49% believe that they themselves are fairly paid
  • 83% said that pay was either no factor or only a minor factor in the specialty they chose, with only 14% saying it was the leading factor
  • Male specialists earned 31% more than female specialists, indicating a widening gender gap compared to 27% last year
  • 57% of radiologists were happy with their compensation, sixth among 29 medical specialties

Physician comments submitted to Medscape focused on the significant stress being experienced by many physicians, a phenomenon that’s been linked to burnout in other surveys. 

The Takeaway

Underlying this year’s Medscape data is an inconvenient truth for radiologists: their 3.1% pay gains for the year were not enough to keep pace with the US inflation rate of 3.4%. In that respect, radiologists find themselves in the same situation as most Americans.

MSK Problems Weigh Down Interventional Radiologists

Posted on by Brian Casey

Musculoskeletal problems are common among interventional radiologists, caused by many hours wearing heavy radiation protection gear. That’s according to a new study in European Journal of Radiology which found that almost half of interventionalists suffered from multiple orthopedic problems, issues that forced a significant portion to either reduce or stop their interventional practice. 

Interventional radiology has been responsible for major improvements in patient care through image-guided procedures that are noninvasive and can eliminate the need for open surgery, reducing patient recovery times to hours rather than days.

  • But these advances can come at the cost of higher radiation doses to the personnel who perform and assist with interventional radiology procedures, which has led to issues such as higher breast cancer rates among women who work with image-guided procedures and even DNA damage in cases of long-term exposure.

Radiation protection gear is worn by interventionalists to mitigate that radiation risk, but this gear is heavy and can carry risks of its own, which were investigated by researchers from the University Hospital Marburg in Germany. They conducted a 17-question survey of orthopedic problems among interventional radiologists, receiving 221 responses indicating that …

  • Some 48% of responders experienced more than five orthopedic problems during their interventional career
  • Problems of the lumbar spine were reported by 82% of respondents, followed by cervical spine (33%), shoulder (29%), and knee (25%)
  • Orthopedic problems caused 16% of respondents to reduce their interventional activities, and 2.7% to stop their practice altogether
  • Just 16% of respondents said they had never experienced an orthopedic problem in their career

The new findings track with previous research highlighting the toll that radiation protection gear takes on interventional personnel. The researchers said that one positive finding of their study was that all interventional radiologists reported wearing radiation protection, although fewer respondents reported using radiation glasses (49%) or visors (11%) despite radiation’s known risk of cataracts.

The Takeaway

This study indicates that interventional radiologists are caught between a rock (radiation dose) and a hard place (orthopedic problems). Relief could come from companies that are developing radiation protection solutions such as free-hanging radiation protection gear; for interventional personnel, these options can’t come soon enough.

Radiology’s Enduring Popularity

Posted on by Brian Casey

Radiology is seeing a resurgence of interest from medical students picking the specialty in the National Resident Matching Program (NRMP). While radiology’s popularity is at historically high levels, the new analysis shows how vulnerable the field is to macro-economic trends in healthcare. 

Radiology’s popularity has always ebbed and flowed. In general the field is seen as one of the more attractive medical specialties due to the perception that it combines high salaries with lifestyle advantages. But there have been times when medical students shunned radiology.

The new paper offers insights into these trends. Published in Radiology by Francis Deng, MD, and Linda Moy, MD, the paper fleshes out an earlier analysis that Deng posted as a Twitter thread after the 2023 Match, showing that diagnostic radiology saw the highest growth in applicants to medical specialties over a three-year period.

Deng and Moy analyze trends in the Match over almost 25 years in the new study, finding…

  • The 2023 Match in radiology was the most competitive since 2001 based on percentage of applicants matching (81.1% vs. 73.3%)
  • 5.9% of seniors in US MD training programs applied to diagnostic radiology in the 2023 Match, the highest level since 2010
  • Fewer radiology residency slots per applicant were available in 2023 compared to the historical average (0.67 vs. 0.81) 

Interest in radiology hit its lowest levels in 1996 and 2015, when the number of applicants fell short of available radiology residency positions in the Match. It’s perhaps no surprise that these lows followed two major seismic healthcare shifts that could have negatively affected job prospects for radiologists: the “Hillarycare” healthcare reform effort in the early 1990s and the emergence of AI for healthcare in the mid-2010s. 

Hillarycare never happened, and Deng and Moy noted that outreach efforts to medical students about AI helped reverse the perspective that the technology would be taking radiologists’ jobs. Another advantage for radiology is its early adoption of teleradiology, which enables remote work and more flexible work options – a major lifestyle perk. 

The Takeaway

The new paper provides fascinating insights that support why radiology remains one of medicine’s most attractive specialties. Radiology’s appeal could even grow, given recent studies showing that work-life balance is a major priority for today’s medical students.

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