A new Harvey L. Neiman Health Policy Institute study quantifies and characterizes recent trends in the “generalist” versus “subspecialist” composition of the national radiologist workforce. The study is published online in the Journal of American Radiology.
In carrying out their work, the researchers leveraged CMS Medicare Physician and Other Supplier Public Use Files from 2012 through 2017. Work relative value units (RVUs) associated with radiologists’ billed claims were mapped to subspecialties using the Neiman Imaging Types of Service system to classify radiologists as subspecialists when their RVUs exceeded more than half of their billed work effort in a given subspecialty; those with less than half were classified as “generalists.” Additional practice characteristics for radiologists’ year of medical school graduation, group practice size, and group practice identifiers were also obtained from CMS Physician Compare.
“A range of recent factors could be serving to disrupt the historic balance of these two groups. The growing demand for 24/7 radiology services, increasing volumes, expectations for robust patient access in rural and critical access areas, could all promote more demand for generalist radiologists,” says Andrew Rosenkrantz, MD, MPA, lead study author, professor and director of health policy in the department of radiology at NYU Grossman School of Medicine and a Neiman Institute affiliate senior research fellow.
“On the other hand, the growing complexity of medical care, ongoing consolidation of radiology practices into larger groups, as well as the technical ease of interpreting remotely performed imaging studies could all foster more demand for subspecialists,” Rosenkrantz adds.
The percentage of radiologists practicing as subspecialists increased from 37% in 2012 and 2013, to almost 45% in 2017. By subspecialty during the study time period, workforce changes were greatest seen in breast, +3.7%; abdominal, +2.4%; and neuroradiology, +1.8%. (Decreasing, however, was the interventional subspecialty, with rates dropping 1.2% from 2012 to 2017.) Female radiologists saw the greatest increase in subspecialization over the study period—12%—with subspecialization among early-career radiologists and those working in larger than 100-member groups increasing 10% and 7.2% from 2012 to 2017, respectively.
“While radiology’s growing subspecialization is a positive change in the advancement of more sophisticated care, the potential impact on patient access from a diminishing supply of general radiologists, particularly in rural communities, is not yet known,” writes Richard Duszak, MD, FACR, professor of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute.