As the radiology job market tightens, established radiologists can choose to either protect their own incomes, or support the specialty as a whole by filling positions with young graduates and expanding the duties of a radiologist in general beyond interpretation, according to an article published in the April issue of the Journal of the American College of Radiology.

Authored by David C. Levin, MD, and Vijay M. Rao, MD, of Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, the article explained that following the growth in imaging during the early 2000s, a downturn is underway, with declining volumes set to impact the radiology job market. Recruiting firm Merritt Hawkins reported that radiologists fell from the most sought after specialists in 2003, to 18^th on the list in 2012, noted the authors.

There are a number of causes for the tightening job market, wrote Levin and Rao. As imaging utilization and reimbursement rates decline, radiologists are tending to pick up more hours and take less vacation to maintain income levels. Older radiologists are delaying retirement. PACS and other technological advances are making the current radiologist population more efficient.  

Concerns about the potential overuse of imaging have led to programs like the Choosing Wisely initiative, which is supported by the American College of Radiology (ACR), and while these efforts deserve to be applauded, they will nevertheless have an effect on the market, wrote Levin and Rao. “The ACR did the right thing for our patients and for our healthcare system, and the term admirable seems justified. But awareness among the medical community that some imaging tests are overused will likely lead to a further reduction in their use, and that will further reduce the need for radiologists.”

The authors said the response from practicing radiologists is obvious and more young fellowship graduates need to be hired, even if existing members of a group see a small drop in income. “Instead of outsourcing night and weekend call to a teleradiology company (thereby helping transform our specialty into just a commodity), create a night and weekend or emergency radiology section, and fill the positions with those new young radiologists.”

Other tasks new hires—as well as established radiologists—could perform to strengthen the specialty include:

• Evaluate imaging requests for appropriateness, and consult with ordering physicians to get inappropriate orders dropped or changed to a more appropriate test;
• Directly supervise performance of advanced imaging tests, rather than leaving all duties to technologists;
• Communicate more with patients; and
• Designate a set number of radiologists each day as “consultants” who can help referring physicians with questions regarding imaging.

While some may object to these suggestions, noted Levin and Rao, practicing radiologists have a choice to make about the future of the profession. They could either refuse to hire more young radiologists—who will then likely work more cheaply for teleradiology companies—not perform unreimbursed tasks outside of interpretation and allow the radiology to succumb to commoditization. “Or, we could instead sacrifice some income, create new positions within our practices, take back the nights and weekends, and start acting like real consultants to our colleagues and patients.”