Relative attractiveness of diagnostic radiology: assessment with data from the National Residency Matching Program and comparison with the strength of the job market.

PURPOSE: To quantify medical students' preferences for various specialties and to compare shifts in specialty preference with overall employment market prospects. MATERIALS AND METHODS: By using National Residency Matching Program data, a previously validated help-wanted index (HWI), and American Medical Association (AMA) salary data, the authors quantified medical students' preferences for various specialties and examined the association of shifts in specialty preference with overall trends as seen in the strength of the diagnostic radiology match and its relationship with the job market. The authors established a proxy for the relative attractiveness (RA) of diagnostic radiology (relative to all specialties) in the match, which was calculated by subtracting the percentage fill rate for all specialties from that for radiology. The RA values were plotted for 1990-2000 and compared with trends in the HWI, American College of Radiology data, and AMA salary data. RESULTS: The RA of diagnostic radiology varied greatly during the past 10 years, with a low in 1996 and a return to its high in recent years. There is a relationship between the RA and economic vitality of diagnostic radiology, with the RA lagging behind the HWI and AMA salary data by 2 years. CONCLUSION: Medical students appear to have an in-depth understanding of the economic forces at play in the health care job market and incorporate this information into their choice of a specialty.

The use of volume standards in health services.

The ways in which volume standards are implemented by health services organizations are not clear. Therefore, the authors sought to evaluate the extent of use of volume standards, the purposes for which such standards were developed, and the sources of the standards in a sample of health services organizations. The authors found that volume standards were used widely by accrediting organizations, professional societies, and hospitals in their sample, but almost never by health maintenance organizations. Volume standards were used for ensuring adequate experience among residents, providing guidelines to residency programs, and privileging and credentialing physicians. Expert consensus appeared to be the usual source of volume standards.

Pediatric radiology at the millennium.

PURPOSE: To evaluate the current practice of and job market for pediatric radiologists in the United States and Canada with a 1998 survey and compare findings with those of surveys from 1980 and 1989. MATERIALS AND METHODS: Surveys were mailed to the 728 active members of the Society for Pediatric Radiology. Questions covered professional practice, subspecialization, and involvement in evolving technologies. A pediatric radiology help-wanted index was generated from a diagnostic radiology help-wanted index. RESULTS: Increasing involvement in the interpretation of computed tomographic, ultrasonographic, and magnetic resonance images was found among the 57% (411 of 728) of the members who responded. The attainment of a certificate of added qualification in pediatric radiology was found in nearly three-fourths of the membership, and 85% (348 of 408) had completed a fellowship. More than half of the respondents were involved in interventional procedures amid a continued increase in volume; 24% (100 of 409) of the membership, as compared with 7% in the 1980 survey, was practicing in a community or "other" setting. Subspecialization within pediatric radiology had diminished, and there was a larger percentage of female pediatric radiologists, particularly among the newest members. The job market was robust, having recovered substantially since the middle 1990s. CONCLUSION: The practice of pediatric radiology has evolved, with increasing involvement in advanced techniques and modalities, as well as a greater presence in community settings. The help-wanted index supports the recent discussions of a personnel shortfall.

Initial employment experiences of 1997 graduates of radiation oncology training programs.

PURPOSE: To inform the profession of current trends in the job market, the American College of Radiology (ACR) sought to detail the job-hunting experiences and outcomes of 1997 graduates of radiation oncology training programs. METHODS AND MATERIALS: In early 1998, questionnaires were mailed to all graduates; 67% responded. Results were compared with similar surveys of 1996 graduates. RESULTS: Similar to past years, immediately after graduation, 13% of residency graduates and 1 of 10 fellowship graduates encountered serious employment difficulties--that is, spent some time working locums, working outside radiation oncology, or unemployed. By 6-12 months after graduation, approximately 2% of all residency graduates were working outside the profession and approximately 3% were not working at all. Eighty-five percent of residency graduates and 7 of 8 fellowship graduates reported that their employment reasonably matched their training and individual goals. On average, graduates' actual salaries approximately corresponded to expected salaries. Eleven percent of all graduates were in nonownership-track jobs, a significant decline since 1996. For residents and fellows combined, 46% had a job with at least one characteristic some observers associate with a weak job market, but fewer than half of those with one of these characteristics actually disliked it. These percentages are similar to 1996. Women graduates were more likely than men to have spouse-related restrictions on job location but less likely to end up in a self-reportedly undesirable location. CONCLUSION: Unemployment remained low. Some other indicators of the employment market showed improvement, while others did not.

Practice costs in diagnostic radiology.

PURPOSE: To report on practice costs and their variation. MATERIALS AND METHODS: In 1996 and 1997, practices were surveyed, and data on costs and other operational characteristics were obtained from approximately 170 practices. Several components of practice costs (eg, physician-related costs, administrative and business costs) were calculated separately for different group types (eg, academic, private hospital-only), each on four bases: per full-time equivalent (FTE) radiologist, per relevant procedure, per relevant relative value unit (RVU), and as a percentage of revenue. RESULTS: Median total practice costs per FTE radiologist ranged from approximately $90,000 to $190,000, depending on group type. Per procedure, the median ranged from $9 to $21; and as a percentage of revenue, it ranged from 27% to 41%. Median technical costs were approximately $36 per technical RVU in private hospital-and-office groups. Within any category of group, for every cost category, there was substantial variation among groups. CONCLUSION: The sizable variation implies that means or medians should not be regarded as norms. Nonetheless, the data on 75th and 25th percentile costs can show a radiology group where savings and inadequate resources, respectively, are relatively likely to be found. Physician-related costs are best measured per FTE. Technical costs and administrative and business costs are best measured per RVU or for categories of groups defined by having similar percentages of nonhospital services.

The status of radiation oncology training programs and their graduates in 1999.

PURPOSE: To keep the profession apprised of current trends in the job market, the American College of Radiology (ACR) studied the employment situation of 1999 radiation oncology graduates and the status and plans of radiation oncology training programs. METHODS AND MATERIALS: During mid-April to the beginning of June 1999, the ACR surveyed all radiation oncology residency directors about the employment situation of their residency and fellowship graduates, changes in their programs, and incoming trainees. Eighty-four percent (74/88) responded. We compared current findings to those of similar surveys conducted over the 1995-1998 period and report statistically significant differences (p < or = 0.05. RESULTS: Directors responded that as of the survey date, 88% (71/81) of all residency graduates had secured commitments for a position, about the same as reported throughout the 1995-1998 period. Planned and accomplished changes in residency program size since 1993 will reduce the annual number of beginning residency slots by approximately 33. This represents about a 20% decrease in the number of graduates relative to the 160 typical during the early 1990s. Residency directors' perceptions of the job market were optimistic, with 40% viewing the market as "somewhat" or "much" better than in recent years vs. 13% viewing it as worse, much as in 1998. On average, directors viewed 1999's residency applicants as, if anything, somewhat better than those who had applied one or three years earlier. CONCLUSION: Directors' perceptions of graduates' job prospects remain optimistic, and the employment situation remains the same as in past years, when reported unemployment was approximately 1%-2% or less by six months after graduation.

1997 Graduates Speak: initial employment experiences of residency and fellowship graduates.

OBJECTIVE: The American College of Radiology sought to detail the initial employment experience of 1997 diagnostic radiology graduates and recent trends. MATERIALS AND METHODS: In early 1998, questionnaires were mailed to all graduates; 65% responded. Results were compared with similar surveys of 1995 and 1996 graduates. RESULTS: Much as in past years, immediately after graduation 4% of residency graduates and 9% of fellowship graduates spent some time working as a locum tenens, working outside radiology, or unemployed, but by 6-12 months after graduation, 2% or fewer were not employed. The median fellowship graduate's salary was 5% greater than in 1996. Twelve percent of fellowship graduates were in non-ownership-track jobs, much the same as in earlier years. Thirty-two percent had one or more of 12 possibly undesirable job characteristics, down from 39% in 1996; 14% not only had, but actually disliked, one or more of these characteristics, much the same as in 1996, but down from 23% in 1995. Multivariate analysis showed that women graduates were more likely than men to have had serious employment difficulties in the immediate postgraduation months; and that graduates having a spouse who also had to find a job in the same area were more likely than others to be in a putatively "seriously undesirable" location or in "holding pattern" employment while looking for something better or more permanent. CONCLUSION: Unemployment remained very low. Some other indicators of the employment market showed improvement. Factors expected to affect employment outcomes-for example, training program quality or having major non-spouse-related restrictions on job location-had surprisingly little effect.

The status of diagnostic radiology training programs and their graduates in 1999.

OBJECTIVE: To address job market concerns, the American College of Radiology studied the employment of 1999 graduates from diagnostic radiology training programs and the programs' status and plans. MATERIALS AND METHODS: In late April to the beginning of June 1999, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment status of their 1999 residency and fellowship graduates as well as about plans for their training programs. Seventy-seven percent responded. We compared findings from the 1999 survey with similar findings from earlier surveys using a p value of less than or equal to 0.05 to define statistical significance. RESULTS: As of the survey, 95% of residency graduates and 96% of fellowship graduates were reported to have commitments for positions. Ninety-two percent of graduating residents and 95% of graduating fellows reportedly had commitments for positions that reasonably matched their training and personal goals. Completed plus planned changes in residency program size since 1993 would, if implemented, lead to an 8% reduction. Similar to previous years, 96% of the beginning-year residency slots were filled. Program directors reported that the job market had improved compared with that of recent years. The percentage of graduating fellows with commitments for positions was similar in almost all fields. CONCLUSION: Fellows found jobs earlier than in past years, when unemployment among graduates decreased to 1-2% by 6 months after graduation. Results in 1999 should be at least as good. Employment prospects across all subspecialties are about the same. Planned program reductions are much smaller than those reported in 1998 and may continue to evaporate.

Role of emergency medicine physicians in US performed in patients in the emergency department: how substantial is their participation?

PURPOSE: To determine the extent to which emergency medicine physicians have assumed responsibility for performing and interpreting ultrasonographic (US) studies in emergency departments (EDs) in the United States. MATERIALS AND METHODS: The national 1997 Medicare Part B database was searched by using standard US procedure codes, location codes, and physician specialty codes. The authors determined how many US studies were performed in EDs and what percentage of those studies were performed by emergency medicine physicians, radiologists, or other physicians. RESULTS: During 1997, 234,820 ED US studies within nine major examination categories were performed in Medicare patients nationwide. Emergency medicine physicians performed 1,551 (0.7%) of these studies. When echocardiographic examinations were excluded, emergency medicine physicians performed 458 (0.2%) of the remaining total of 196,158 studies. CONCLUSION: Although emergency medicine physicians have claimed to be actively involved in ED US on a broad scale, the data reveal that their involvement in 1997 was minimal. This raises doubt as to whether they can properly train their residents to perform US or maintain their own competence at acceptable levels.

Power Doppler imaging: initial evaluation as a screening examination for carotid artery stenosis.

PURPOSE: To evaluate power Doppler imaging as a possible screening examination for carotid artery stenosis. MATERIALS AND METHODS: In the principal pilot study, a prospective, blinded comparison of power Doppler imaging with duplex Doppler imaging, the reference-standard method, was conducted in 100 consecutive patients routinely referred for carotid artery imaging at a large, private multispecialty clinic. In the validation pilot study, a prospective, blinded comparison of power Doppler imaging with digital subtraction angiography, the reference-standard method, was conducted in 20 consecutive patients routinely referred at a teaching hospital. Using conservative assumptions, the authors performed cost-effectiveness analysis. RESULTS: Power Doppler imaging produced diagnostic-quality images in 89% of patients. When the images of the patients with nondiagnostic examinations were regarded as positive, power Doppler imaging had an area under the receiver operating characteristic curve, A(z), of 0.87, sensitivity of 70%, and specificity of 91%. The validation study results were very similar. The cost-effectiveness of screening and, as indicated, duplex Doppler imaging as the definitive diagnostic examination and endarterectomy was $47,000 per quality-adjusted life-year. CONCLUSION: The A(z) value for power Doppler imaging compares well with that for mammography, a generally accepted screening examination, and with most other imaging examinations. Power Doppler imaging is likely to be a reasonably accurate and cost-effective screening examination for carotid artery stenosis in asymptomatic populations.

Diagnostic radiologists' subspecialization and fields of practice.

OBJECTIVE: The purpose of this study was to explore the diagnostic radiology profession from the perspective of subspecialization and fields of practice. MATERIALS AND METHODS: Data for 1244 practicing diagnostic radiologists were gathered from the American College of Radiology's 1995 Survey of Radiologists. Radiation oncologists, the retired, and residents and fellows were excluded. Responses were weighted to represent all practicing diagnostic radiologists in the United States and were compared with a similar previous survey. RESULTS: More than one quarter (28%) of diagnostic radiologists are subspecialists. Diagnostic radiology subspecialists were more likely than generalists to have fellowship training, work in center cities, work in large groups, and be employed by an academic institution. They were also generally younger and provided a narrower range of imaging services than generalists. CONCLUSION: Although most diagnostic radiologists are generalists, subspecialization will likely continue to grow.

Changes in the market for diagnostic radiologists as measured through a help wanted index.

OBJECTIVE: We sought to create and validate a help wanted index for tracking changes in the radiology job market. SUBJECTS AND METHODS: All jobs advertised in Radiology and the American Journal of Roentgenology from January 1991 through December 1998 were tracked according to three separate parameters: academic versus private practice, subspecialty, and region. Statistical comparison was made between the first and second 48-month subperiods to identify changes. RESULTS: Thirteen thousand seven hundred one advertised positions were coded. A dramatic decrease in job advertisements was noted after December 1991, with advertisements falling to one eighth of their late 1991 peak. A recovery has occurred, with advertising now approaching peak levels. Shifts were seen toward more private practice, midwestern location, vascular and interventional, and mammography positions. Declines occurred in the share of positions in California, the Southwest, and several radiology subspecialties. Other trends were noted but were statistically less significant. A strong correlation (R = 0.98) was found between the annual number of positions advertised and radiologists' median incomes relative to those of all physicians. CONCLUSION: The job market in radiology, much as in other fields, can be tracked in a coincident manner with the use of a help wanted index. Changes in the makeup of radiology practice are important and are identified in a well-constructed index. These findings have validity and can be useful as an adjunct to other information for policy and planning purposes.

Radiology groups' workload in relative value units and factors affecting it.

PURPOSE: To measure diagnostic radiology groups' workload in physician work relative value units (RVUs) and identify factors affecting it. MATERIALS AND METHODS: In 1996 and 1997, the authors surveyed diagnostic radiology and radiation oncology groups regarding finances, workload, and basic characteristics. The study was based on approximately 100 diagnostic radiology groups. The authors analyzed the distribution of workload in different categories of groups, conducting multiple statistical analyses. RESULTS: The annual numbers of procedures were approximately 10%-15% lower than those in a comparison survey with a good response rate. The annual number of RVUs per full-time equivalent (FTE) diagnostic radiologist was highly variable in every group category, as was the number of RVUs per clinical work hour. Multivariate regression analysis indicated that variation in the annual number of hours worked did not explain variation in annual workload. RVUs per FTE radiologist were higher the greater the percentage of a group's workload from interventional, computed tomographic, and magnetic resonance imaging procedures. CONCLUSION: Given the likely response bias, the annual workload per FTE radiologist probably averaged approximately 4,000 RVUs in academic groups and approximately 6,000 in nonacademic groups, but the large, unexplained variance means the average values should not be taken as norms.

The situation of radiation oncology practice training programs and their graduates in 1998.

PURPOSE: To keep the profession apprised of current trends in the job market, the American College of Radiology (ACR) studied the employment situation of 1998 radiation oncology graduates and the status and plans of radiation oncology training programs in the United States. METHODS AND MATERIALS: In April-May 1998, and again in a December 1998-January 1999 follow-up, the ACR surveyed all radiation oncology residency directors in the U.S. about the employment situation of their 1998 residency and fellowship graduates as well as changes in their programs. Eighty-five percent (71/84) of those surveyed responded. We compare current findings with similar 1997 and earlier surveys and report statistically significant differences (p < or = 0.05). RESULTS: By 6 months after graduation, there were no graduating residents or fellows who had not secured a position, although the status of two was unknown. At that time, about 93% of all graduates had secured positions that directors said reasonably matched graduates' training and personal goals. Program directors reported that accomplished and planned changes in their programs will reduce the annual number of residency graduates by about one-fifth since 1993. However, the number of beginning residency positions offered in 1998 was 149, up from 116 in 1997 and only a few percent below the 1993 level. By the December 1998-January 1999 follow-up, fill rates for offered training positions were 94% for residencies and 80% for fellowships, figures that are similar to those reported for past years. Directors' perceptions of the job market are much more positive. For example, only 11% of residency directors viewed the market as more difficult this year than typical of recent years, as against 48% in 1997 and 82% in 1996. CONCLUSION: Unemployment continues to be low, and another, "softer" indicator, the job market perceptions of residency program directors, continues to improve. Possibly as a result, plans for program reductions are evaporating.

Radiology at the turn of the millennium.

Herein, the authors (a) review the status of the specialty; (b) report and analyze the various areas in which progress has occurred, namely, conventional radiology and picture archiving and communication systems (or PACS), ultrasonography, computed tomography, magnetic resonance imaging, interventional radiology, and nuclear medicine; and (c) discuss the problems radiology faces as it enters the new millennium. The problems are those facing medicine as a whole, as well as those threatening the future of radiology. These include the following: Will there be a need for radiologists in the future? Will radiology be too costly to be affordable? How can turf wars and fragmentation be solved? Possible remedies are suggested. Positive aspects are discussed in the light of the challenge to demonstrate value. Medical imaging is entering the new millennium with a solid record of recent advances in digital, cross-sectional, and interventional radiology. These advances have made the specialty indispensable in the treatment of patients. Careful statesmanship will be needed to solve the many problems that face medicine as a whole and radiology in particular.

Hiring of diagnostic radiologists in 1997.

OBJECTIVE: We sought to determine the hiring activities of physician groups with respect to diagnostic radiologists. MATERIALS AND METHODS: A survey was mailed to a stratified, random sample of 589 groups of physicians in the autumn of 1997; 76% responded. Responses were weighted to represent all practices in the United States that have more than one radiologist. Findings were compared with results of similar, previous surveys. RESULTS: In the 12 months before the survey, groups sought to hire 1909 (+/-111[SE]) diagnostic radiologists; 888 (+/-77) of these jobs were new positions, the rest were replacements for radiologists who left groups. Groups did not seek to refill another 366 (+/-57) positions that had been vacated during these 12 months. Groups succeeded in hiring 1488 (+/-92) diagnostic radiologists. Generally, the percentage of available positions that groups succeeded in filling did not differ among subspecialty fields. A greater perceived effect of managed care on a group was associated with fewer expansion positions and less likelihood that positions were offered on a partnership-track basis but otherwise was unrelated to hiring activity. Eighty-one percent of available positions were in groups that preferred recently trained radiologists to those with 10-20 years' experience; 28% of full-time positions in private nonacademic groups were not partnership-track. CONCLUSION: The decline in hiring evident during 1991-1995 has reversed. In the year ending in the autumn of 1997, for the first time in recent years, positions available exceeded radiologists to fill them; the excess was approximately 278 positions.

Professional satisfaction of U.S. radiologists during a period of uncertainty.

PURPOSE: To identify and explain variations and trends in the professional satisfaction of radiologists. MATERIALS AND METHODS: Questionnaires were mailed during the winter of 1994-1995 to a stratified random sample of 3,024 diagnostic radiologists, radiation oncologists, and nuclear medicine specialists; 75% responded. We weighted the responses to make them representative of all radiologists in the United States and compared the findings with those of similar previous surveys. RESULTS: Fifty-one percent of radiologists would recommend a career in radiology to a college-age adult, which is down from 65% in 1990 but up from 42% in 1998. Forty-one percent said they liked working in radiology less than they did 5 years ago, whereas 22% said they liked it more. Radiologists' perceptions of managed care's effect on their practice had more influence on professional satisfaction than did its administrative intrusions or the actual percentage of managed care patients in their practice. Other factors associated with decreased satisfaction were increased administrative duties and government involvement. CONCLUSION: Satisfaction in the radiology profession declined during a period of dramatic change and uncertainty. Fear about managed care rather than its actual effect was the dominant factor in the decrease. Therefore, it is unsound to predict a long-term decline in professional satisfaction.

The situation of diagnostic radiology training programs and their graduates in 1998.

OBJECTIVE: In light of concerns about the job market, the American College of Radiology studied the employment situation of 1998 graduates from diagnostic radiology training programs and the status and plans of the programs. MATERIALS AND METHODS: In April and May 1998, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment situation of their 1998 residency and fellowship graduates and about their programs. Ninety-one percent of those surveyed responded. We compared findings from the 1998 survey with similar findings from the 1997 survey, with a p value less than or equal to .05 representing statistical significance. RESULTS: Similar to 1997, 96% of residency graduates and 89% of fellowship graduates had commitments for posttraining jobs or fellowships as of the survey date. Approximately 92% of graduates had positions that directors believed reasonably matched their training and personal employment goals. The percentage of fellows with positions was similar across subspecialty fields. Completed plus planned changes in program size for residents would gradually lead to a 21 % reduction in the annual number of graduates within the next 4 years. Much as in previous years, by late April to mid May 1998, 94% of beginning-year residency slots were filled. Residency program directors were more optimistic in 1998 about graduates' job prospects than in the previous 3 years. CONCLUSION: In past years, unemployment of graduates was less than 1% by 6 months after graduation, and that is the likely outcome for 1998 graduates. Employment prospects across all subspecialty areas are approximately equal.