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Changing Tides

Radiologists approaching retirement may have a sustainable role in a swiftly moving healthcare landscape.

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When considering what the future of radiology will look like — maybe 10 years from now — you might have visions of AI commanding imaging practices. You may see women and minorities assuming top leadership positions. Perhaps you believe behemoth healthcare groups will continue swallowing up smaller practices. Your best guesses aside, one future change is certain — a significant, aging physician workforce
will give way to younger radiologists with different skill sets.

It behooves the radiology leaders of today to recognize the coming transition and prepare for fewer staff and changing roles. “There are radiologist shortages already, especially in rural areas,” says Catherine J. Everett, MD, MBA, FACR, chair of the ACR Senior and/or Retired Section and a diagnostic radiologist at Coastal Radiology in New Bern, N.C. “There are not enough people to do the work, practices don’t have enough resources, and healthcare is changing and increasingly dependent on imaging.”

A national shortage of specialty physicians — potentially upwards of 31,000 by 2030 — poses a real risk to patients. With the baby boomer sector of the workforce nearing retirement age, many radiology managers will be looking for emerging leaders to sustain their practices. Because
the time needed to bring a new physician up to speed is substantial — and with a third of practicing full-time radiologists now age 55 or older — the retirement wave matters for all members of a radiology group.1,2

Trusted Resources

“You can’t teach experience; it just comes with time,” notes Efrén J. Flores, MD, officer of radiology community health improvement and equity at Massachusetts General Hospital. “When I sit down with a more senior radiologist, it’s a fascinating learning experience,” he says. “Just listening to how they approach the cases and listening to stories about the department — how it once was and how it has evolved — is helpful.You can’t afford to disregard that kind of information.”

Keeping experienced radiologists can benefit everyone, Flores believes. According to Flores, phasing out of the everyday routine of full-time clinical work can be difficult for more senior radiologists who are accustomed to performing at a high level all the time. “But taking on new roles within the organization can lead to valuable mentoring opportunities to junior faculty, in addition to the education of students and other specialists, with whom they are a trusted voice,” he says.

A primary care doctor, for example, who is accustomed to listening to and learning from a particular radiologist about X-rays or CT scans will feel the effect of that specialist’s retirement, Flores says. “Senior radiologists also have a lot of leverage at radiological society events and state
chapter meetings,” he says. “Their words may carry more weight because they have experienced certain situations firsthand.”

Changing Roles

A quarter of radiology practice leaders surveyed report at least one radiologist retiring from their practice in the past year. Those same leaders say they still employ a once-retired radiologist “in some capacity.”2 This is telling in two ways. One, high-functioning physicians may be reluctant to step away from lifelong service altogether. Two, there are challenging gaps to fill when they leave.

Giving senior radiologists as many options as possible when nearing retirement can alleviate transition anxiety. “We’ve had some success letting people phase out over a four-year period,” says John J. Cronan, MD, FACR, chair of diagnostic imaging at Rhode Island Hospital and professor at Brown University School of Medicine. “They start out working a four-day work week, then a three-day week, two days, and so on. They only take call for the first year or so and then there’s no call at all.”

Many senior radiologists want to remain an active part of a group if they feel their contributions are still valuable, Cronan says. That may mean consulting for hospitals or assuming an advisory committee position. But there is plenty of clinical work too if they want it, he notes. “I know a radiologist who came back to work just to read plain films,” Cronan says. “The younger doctors don’t want to do that. They’ll read an MRI over an abdominal X-ray.”

There is an underestimated need for general radiology skills, says Travis Singleton, executive vice president at Merritt Hawkins, a national physician search/recruiting firm. “A subspecialist radiologist coming out of training or fellowship is not close to what a radiologist was 10 years ago when you look at productivity patterns,” he says. “My message to employers is that the majority of the general radiologists you have left are the ones who are nearing retirement. They are going to slow down at some point and leave, and their replacement is going to be more subspecialized and work much less if current production holds. The numbers I have seen indicate that average RVUs per radiologist have declined from 10,200 in 2006–2007 to 8,907 in 2016 — a clear indicator of where things are going.”
 
“We love fellowship-trained subspecialists,” notes Everett. “But you’ll come across some who can’t do anything outside their subspecialty. So there may be a huge shortage of radiologists with light IR skills, for instance, who can function in a smaller, 100-bed hospital.”
 
Keeping senior radiologists around longer — in some capacity — could mitigate these types of potential problems. Phasing-out strategies requiring less volume, targeting select modalities, and mandating fewer on-call shifts can incentivize older radiologists. Still, there are other factors that make it difficult for managers to accommodate everyone.
 

Generational Drivers

 
Discussing options to keep more senior radiologists active within a group can become a contentious conversation with younger members pushing for change. Radiology leaders should be mindful of personality clashes that may disrupt workflow or compromise quality of care.3
 
“You need some incentives for the older radiologists to stay,” Cronan says, “but you also need new blood coming in.” Fewer personal relationships with colleagues can drive older radiologists into retirement, Cronan says, and there’s probably no way to fix that. But they may also be encumbered by the newer computer systems and administrative tasks that may not seem as formidable to younger radiologists.
 
When building your future staff, “your practice really needs a good mix,” Flores says. “You should embrace senior members but have an even mix of mid-career and young faculty.” The mid-career radiologists need to transition at some point to the senior level positions, he says, while senior radiologists can offer guidance to younger staff while taking on smaller roles. “We all need to go through the right steps to move up to the
next spot in line,” says Flores.
 
As the shuffling of radiologists, from older to younger, plays out over the next decade, certainly workforce demands will change. For now, the radiology job market is robust, Singleton says. Salaries are generally not a source of concern for job seekers, he adds. They focus more, he says, on finding a position that puts their subspecialty skills to use while working fewer hours. “It’s already hard to find enough ‘boots-on-the-ground’ general radiologists to fill positions and cover the work. Five years ago, we thought these jobs would be irrelevant, and it hasn’t proven to be that way,” Singleton says.
 
“As radiologists, we are on the forefront of healthcare and technology,” Flores says. “But we still need to foster professional relationships and interact with those who’ve paved the way for us. Embrace them while you still can.”
By Chad Hudnall, senior writer, ACR Press
 
ENDNOTES
1. Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2015
to 2030. Washington, D.C.: AAMC; 2018. Available at bit.ly/AAMC2017_Report.
2. Bluth EI, Bansal S, Bender CE. The ACR Commission on Human Resources Workforce Survey. J Am Coll Radiol.
2017;14(12):1613–1619. Available at bit.ly/2017_WorkforceSurvey.
3. Harolds JA, Cronan JJ, Coleman BG, Bluth EI. Retirement issues for radiologists, part 2: consensus statement
on retirement and preretirement issues by the commission on human resources of the ACR. J Am Coll Radiol.
2013;10(2):335–340. Available at bit.ly/Retirement_for_Rads.

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