Generalists remain ‘extremely relevant' in radiology despite perceived subspecialization

Radiology has undergone large-scale subspecialization, causing some experts to question how the shift has impacted patient access to both basic and invasive procedures.

Researchers—led by Andrew B. Rosenkrantz, MD, with NYU Langone Health—found generalists perform more procedures in a greater number of locations compared to interventionalists and other subspecialties. Their study was published July 31 in Radiology.

“Despite the ongoing evolution of interventional radiology as a distinct specialty separate from diagnostic radiology and the increasing subspecialization of radiology more broadly,” the authors wrote, “we found an important and ongoing role for generalists in meeting the procedural needs of radiology practices and their patients throughout the country.”

Rosenkrantz and colleagues studied invasive procedures billed by radiologists for Medicare fee-for-service beneficiaries. Data were taken from the 2015 CMS Physician and Other Supplier Public File.

Dividing the radiologists by subspecialty according to their billable work-relative value units, the team found “a rather narrow set” of 25 unique services made up the more than 75 percent of invasive procedures performed in the U.S., Rosenkrantz et al. wrote.

Authors pointed out that no single invasive procedure was undertaken by more than approximately 10 percent of radiologists studied, suggesting “the need to maintain an adequate supply of both generalists and subspecialists who are able to offer the full spectrum of basic and advanced image-guided procedures to meet patient needs,” the researchers argued.

Additional findings were as follows:

  • Generalists accounted for 46 percent of low-complexity, 31 percent of mid-complexity and 23 percent of high-complexity procedures.
  • Interventionalists performed 35 percent, 31 percent and 75 percent of procedures respectively.
  • Other subspecialties accounted for 18 percent, 15 percent and 2 percent of procedures respectively.
  • Generalists were “dominant” providers of six of the top 10 low-complexity and seven of the top 10 mid-complexity procedures.
  • In the U.S., twice as many counties had local access to generalists (869 counties) for invasive procedures compared to interventionalists (347) and other subspecialties (380).

Rosenkrantz and colleagues claimed their results go against the idea that radiology has grown increasingly subspecialized, and rather proves that generalists remain an integral part of the profession.

“[W]hen considering the range of image-guided invasive procedures performed by these specialists as a whole, the reality remains that generalists remain extremely relevant, in that they perform the bulk of procedures performed by radiologists across the country, and they perform all such procedures in the many U.S. counties that do not have an interventional or other radiology subspecialty presence,” the authors wrote.