AJR: Residents list breast imaging disincentives

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Although radiology residents are spending more time in breast imaging rotations, attitudes about breast imaging remain negative, which may feed the gap between patient demand for breast imaging and the supply of breast imaging specialists, according to a study published in the July issue of American Journal of Roentgenology.

Demand for screening mammography is projected to increase, with the number of women in the screening population slated to rise from 75.3 million to 88.6 million in the next 15 years, explained Lawrence W. Bassett, MD, and Chris Bent, MD, both of the department of radiology at David Geffen School of Medicine at University of California, Los Angeles, and colleagues. At the same time, the ratio of radiologists to women in the screening population is projected to drop more than 10 percent. “[Academic] medical centers are encountering difficulties in recruiting breast imaging faculty,” wrote Bassett and Bent.

To better understand resident training in breast imaging and their attitudes regarding breast imaging, the authors administered a web-based survey to a chief or senior resident at 201 radiology training programs and compared results to an identical survey conducted in 2000 and with previous similar surveys.

The number of programs offering a breast imaging rotation swelled from 40 percent in 1990 to 99.5 percent in 2008, with training extended to at least 12 weeks in 95 percent of programs in 2008, up from 73 percent in 2000.

In 2008, 79 percent of residents were aware of differences between screening and diagnostic mammography protocols, a significant drop from the 87 percent who responded affirmatively in 2000. However, in 86 percent of programs dedicated breast ultrasound equipment was available in 2008, a significant increase from 67 percent in 2000.

Although increasing numbers of breast imaging directors or section heads worked exclusively in breast imaging in 2008 compared with 2000, other studies have pegged breast imaging as the radiologist subspecialty with the highest proportion of faculty vacancies, at more than 16 percent, noted Bassett and Bent. The authors identified training academic breast imagers as an ongoing challenge.

The researchers confirmed results of other studies that indicated an increase in the number of breast imaging fellows trained annually, with data suggesting an increase of one-third from 2000 to 2008. However, the researchers reported, “Our results show that most residents continue to have negative attitudes toward the subspecialty.”

Eighty-one percent of residents cited higher levels of stress regarding possible mammography misdiagnosis. Meanwhile, medicolegal concerns remained consistent between 2000 and 2008.

“Perhaps as a result of the overall negative attitudes about breast imaging, 71 percent of the residents in 2008 (up from 65 percent in 2000) agreed or strongly agreed with the statement that mammograms should be interpreted by subspecialists,” wrote Bassett and Bent. In fact, nearly one-fourth of fellowship positions are left unfilled, and 51 percent of residents stated that they would not consider a breast imaging fellowship if offered.

In addition to the professional disincentives cited (not an interesting field, fear of lawsuits and stress), Bassett and Bent identified possible structural reasons why residents may not pursue breast imaging. Specifically, residents typically defer breast imaging until after their first two years, yet they are pressured to apply to fellowship programs by their third year, prior to rich exposure to breast imaging.

To provide exposure and stimulate interest, the authors recommended residents have at least one introductory rotation in breast imaging during the second year of residency and concluded with a call to address the various disincentives “so that residency programs can train adequate numbers of skilled physicians who interpret breast images.”