Residency Push Skips Radiology

A federal push to alleviate the U.S. physician shortage by adding more resident training slots appears to have skipped radiology. Of the more than 400 residency programs awarded funding so far, only two diagnostic radiology programs got funds. 

The ongoing doctor shortage has become a major issue in U.S. healthcare, as physicians face rising patient volume from an aging population with a workforce that’s largely stagnant. 

  • Physicians are already experiencing high burnout rates, and the Association of American Medical Colleges predicts there will be a shortage of as many as 86k doctors by 2036.

Part of the problem is that physician training is tightly controlled in the U.S. Residency programs get most of their funding from Medicare, and there’s been a cap on the number of slots Medicare can fund since 1997.

  • So it takes an act of Congress – literally – to get more money to add residency slots.

That’s actually happened in recent years, with federal budget bills in 2021 and 2023 specifically allocating more money for Direct Graduate Medical Education to help train more residents through what’s commonly known as Section 126.

  • In all, the legislation is funding 1.2k new residency slots, with the positions released through five rounds of funding.

But the fourth round of new resident positions under Section 126, announced in December, skipped diagnostic radiology entirely. 

  • A list of the new positions by Becker’s Hospital Review found no diagnostic radiology slots added to U.S. resident training programs, while 20 interventional radiology positions were added. 

And over the course of the Section 126 program, only 0.5% of residency programs getting funding were diagnostic radiology.

It’s unclear how the omission occurred. Hospitals with resident training programs have to apply for the additional funding, and it’s possible that diagnostic radiology’s low (or nonexistent) numbers simply reflect fewer DR applications.

  • But it’s widely known that the federal government has prioritized training primary care physicians, as well as hospitals in rural areas. Indeed, being in a rural area or health professional shortage area are two of four ways for residency programs to qualify for Section 126 funding.

Legislation currently languishing in Congress – the Resident Physician Shortage Reduction Act of 2025 – would add 14k residency positions over the next seven years. 

  • But even such a large expansion in residency training won’t help medical imaging much if diagnostic radiology continues to get passed over when allocating new positions (the application period for the fifth and final round just opened). 

The Takeaway

The fact that diagnostic radiology is getting skipped over in Section 126 residency funding shows that there’s no cavalry coming over the hill to help the specialty deal with its workforce shortage. Help will have to come from somewhere else, be it AI, teleradiology, or some other kind of technology.

Some Rads Are Working Harder – But Not All

If you feel like you’re working harder than your colleagues, you might not be wrong. New data on changes in imaging volume in the U.S. before and after the COVID-19 pandemic show that while volume grew faster than the supply of radiologists, those reading the most imaging exams shouldered most of the burden.

Medical imaging volume has become a closely watched barometer as radiologists struggle to manage a rising tide of imaging exams with a workforce that’s largely stagnant. 

  • Various technologies – especially AI – have been suggested as possible solutions by enabling radiologists to work more efficiently and churn out more cases per day.

The COVID-19 pandemic complicated efforts to track imaging volume over time, as exam volumes dropped dramatically in 2020 before eventually rebounding. 

  • So how much is imaging volume growing, and how hard are radiologists working to meet demand? 

The new JACR study compared imaging volumes, radiologist workforce growth, and corresponding workload for 1.6k radiologists from 167 U.S. practices before and after the pandemic (December 2017 to February 2024). The researchers found…

  • Imaging exam volume grew 31% over the entire seven-year period, at a 4.6% compound annual growth rate.
  • The number of working radiologists grew 24%, at a CAGR of 3.6%.
  • There was little change in the overall number of exams radiologists read per day over the study period (49.1 vs. 49.4 exams).
  • But the top quartile of radiologists by reading volume was reading 31% more exams/day by the end of the study (from 57 to 74 exams).
  • While bottom-quartile radiologists saw their productivity decline 32% (from 79 to 54 exams).

As a side note, researchers concluded that the COVID-19 pandemic ultimately had a “modest effect” on the number of working radiologists, although rates of part-time work were higher during the pandemic.

The Takeaway

The new findings on imaging volume and radiologist productivity have fascinating implications. In aggregate, it seems that radiologists are keeping pace with rising volumes. But a closer look shows that the burden is falling disproportionately on those radiologists who are most productive – a trend that contributes to burnout among the very professionals the discipline should be working hardest to keep.

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