Faculty Bibliography

OBJECTIVE:To characterize national trends in oncologic imaging (OI) utilization. METHODS:This retrospective cross-sectional study used 2004 and 2016 CMS 5% Carrier Claims Research Identifiable Files. Radiologist-performed, primary noninvasive diagnostic imaging examinations were identified from billed Current Procedural Terminology codes; CT, MRI, and PET/CT examinations were categorized as "advanced" imaging. OI examinations were identified from imaging claims' primary International Classification of Diseases-9 and International Classification of Diseases-10 codes. Imaging services were stratified by academic practice status and place of service. State-level correlations of oncologic advanced imaging utilization (examinations per 1,000 beneficiaries) with cancer prevalence and radiologist supply were assessed by Spearman correlation coefficient. RESULTS:The national Medicare sample included 5,030,955 diagnostic imaging examinations (1,218,144 of them advanced) in 2004 and 5,017,287 diagnostic imaging examinations (1,503,490 of them advanced) in 2016. In 2004 and 2016, OI represented 3.9% and 4.3%, respectively, of all imaging versus 10.8% and 9.5%, respectively, of advanced imaging. The percentage of advanced OI done in academic practices rose from 18.8% in 2004 to 34.1% in 2016, leaving 65.9% outside academia. In 2016, 58.0% of advanced OI was performed in the hospital outpatient setting and 23.9% in the physician office setting. In 2016, state-level oncologic advanced imaging utilization correlated with state-level radiologist supply (r = +0.489, P < .001) but not with state-level cancer prevalence (r = -0.139, P = .329). DISCUSSION/CONCLUSIONS:Oncologic imaging usage varied between practice settings. Although the percentage of advanced OI done in academic settings nearly doubled from 2004 to 2016, the majority remained in nonacademic practices. State-level oncologic advanced imaging utilization correlated with radiologist supply but not cancer prevalence.

RATIONALE AND OBJECTIVES/OBJECTIVE:To assess the prevalence and associated factors of burnout among U.S. academic radiologists. MATERIALS AND METHODS/METHODS:An online survey was sent to the radiologists who were full members of the Association of University Radiologists in December 2018. Burnout was measured using the abbreviated Maslach Burnout Inventory Human Services Survey. Survey respondents were also requested to complete questions on demographics, potential professional stressors, sense of calling, and career satisfaction. Associations between survey participants' characteristics and burnout were tested using logistic regression model. RESULTS:The survey response rate was 27% (228/831). Twenty-nine percent met all three criteria for high burnout, including high emotional exhaustion, high depersonalization, and low personal accomplishment. Seventy-nine percent had one or more symptoms of burnout. Numerous factors including work overload, inability to balance personal and professional life, lack of autonomy, lack of appreciation from patients and other medical staff were significantly associated (p < 0.05) with high burnout. Older age (OR, 0.95; 95%CI 0.92-0.98; p < 0.05), higher number of years of experience practicing as radiologists (OR, 0.95; 95%CI 0.92-0.98; p < 0.05), and holding academic rank of professor (OR, 0.25; 95%CI 0.11-0.56; p < 0.05) were factors associated with lower odds of experiencing burnout. Radiologists with high burnout were more likely to be dissatisfied with their career (OR, 2.28; 95%CI 1.70-3.07; p < 0.0001) and less likely to identify medicine as a calling. CONCLUSION/CONCLUSIONS:Multiple factors contribute to high burnout in academic radiologists. Familiarity with these factors may help academic radiology departments to develop strategies to promote health and wellness of their faculty.

PURPOSE/OBJECTIVE:The aim of this study was to assess recent trends in the generalist versus subspecialist composition of the national radiologist workforce. METHODS:Practicing radiologists were identified using 2012 to 2017 CMS Physician and Other Supplier Public Use Files. Work relative value units associated with radiologists' billed claims were mapped to subspecialties using the Neiman Imaging Types of Service to classify radiologists as subspecialists when exceeding a 50% work effort in a given subspecialty and as generalists otherwise. Additional practice characteristics were obtained from CMS Physician Compare. Chi-square statistics were computed. RESULTS:The percentage of radiologists practicing as subspecialists increased from 37.1% in 2012 and 2013 to 38.8% in 2014, 41.0% in 2015, 43.9% in 2016, and 44.6% in 2017. By subspecialty, 2012 to 2017 workforce changes were as follows: breast, +3.7%; abdominal, +2.4%; neuroradiology, +1.8%; musculoskeletal, +0.8%; cardiothoracic, +0.2%; nuclear, -0.2%; and interventional, -1.2%. Increased subspecialization overall was consistently observed (P < .05) across cohorts defined by gender, years in practice, practice size, and academic status. The degree of increasing subspecialization was greatest for female (+12.1%) and earlier career (+10.2% for those in practice <10 years) radiologists and those in larger groups (+7.2% for ≥100 members). Subspecialization increased in 45 states, and state-level increased subspecialization correlated weakly with population density (r = +0.248). CONCLUSIONS:In recent years, the national radiologist workforce has become increasingly subspecialized, particularly related to shifts toward breast imaging, abdominal imaging, and neuroradiology. Although growing subspecialization may advance more sophisticated imaging care, a diminishing supply of generalists could affect patient access and potentially separate radiologists across workforce sectors.