Radiology subspecialization gains ground

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Subspecialization in the field of radiology is on the rise, but only a minority of radiation oncologists choose this path, according to a study in the March issue of the Journal of the American College of Radiology.

In January 2008, the chair of the American College of Radiology (ACR) Board of Chancellors, Arl Van Moore Jr., MD, commissioned a study of trends in subspecialization in radiology and radiation oncology. Residents and fellows, as well as postgraduate, professionally active radiologists and radiation oncologists, were included.

The data for this study are the result of a group of surveys conducted from April through October 2008 by ACR economics and health policy staff and independent agencies. The

ACR provided a random sample of 6,000 postgraduate, professionally active radiologists from their membership records.

Geoffrey G. Smith, MD from Casper Medical Imaging in Casper, Wyo., and James H. Thrall, MD, from the department of radiology at Massachusetts General Hospital in Boston, and colleagues found that 24 percent of practicing radiologists did not have main subspecialties, and the remainder reported being at least somewhat subspecialized. Neuroradiology (17.1 percent) was the most frequently cited main subspecialty; other subspecialties with double-digit responses were breast imaging or mammography, interventional or vascular radiology, and body imaging or cross-sectional imaging.

The researchers found that about 70 percent of radiation oncologists considered their main subspecialties to be in body parts or organ systems: prostate (18.9 percent), breast (17.7 percent) and head and neck (17.1 percent); and were the most prevalent; "other" also received relatively numerous responses (6.9 percent).

The authors found that most radiologists (62.9 percent) and a minority of radiation oncologists (29.9 percent) reported recent expansions of subspecialization within their practices. Also, survey data showed that 76.6 percent of radiologists and 69.4 percent of radiation oncologists were satisfied with the extent of their subspecialization.

According to the investigators, the differences between the specialties are striking. Over 90 percent of radiologist trainees planned on fellowship training, whereas fewer than one in 10 radiation oncology residents pursued this pathway.

Despite the lack of additional training, Smith and colleagues reported that many radiation oncology residents (42.7 percent) still wished to subspecialize. About 67 percent of radiology trainees wished to work in two or more areas once in practice. About three-quarters of radiology trainees felt moderate or much pressure to subspecialize. Conversely, three-quarters of radiation oncology trainees felt little or none of this stress.

Radiologists identified significantly more stress from referring physicians to subspecialize, and in response, radiology trainees far outnumber radiation oncologists in their pursuit of fellowship training, according to the authors.

Despite the growth of subspecialty care, Smith and colleagues concluded that generalists remain a substantial portion of practitioners in both fields-a significant amount of subspecialists' time is devoted to work they describe as "general."