Faculty Bibliography

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.

RATIONALE AND OBJECTIVES/OBJECTIVE:Occupational "horizontal segregation," defined as disparity in the distribution of responsibilities between genders, could discourage women from seeking careers in radiology, as well as impact women within radiology in terms of compensation, promotion, and career advancement. We aimed to explore the existence of horizontal workplace segregation in radiology, as potentially manifested as intergender differences in the distribution of clinical work effort among imaging modalities for radiologists. MATERIALS AND METHODS/METHODS:Medicare-participating general radiologists, neuroradiologists, abdominal, cardiothoracic, and musculoskeletal radiologists were identified from the 2016 Medicare Physician and Other Supplier Public Use File. Work effort in radiography, ultrasound, CT, and MRI was stratified by gender. Univariable and multivariable analyses were performed. RESULTS:22,445 radiologists were included (19.0% female; 19.6% in academic practices). At univariable analysis, female (vs. male) generalists had lower work effort in MRI (10.2% vs. 13.2%) (p < 0.001); abdominal radiologists had higher work effort in ultrasound (27.1% vs. 21.9%), with lower work effort in CT (53.7%. vs. 56.0%) and MRI (8.1%. vs. 9.4%) (p < 0.001); and musculoskeletal radiologists had higher work effort in radiography (41.6% vs. 34.8%) and less in MRI (44.8% vs. 49.6%) (p = 0.007). In multivariable analyses, female gender was independently associated with lower work effort in advanced imaging (CT and MRI) for generalists (coefficient, -0.020; p < 0.001), abdominal radiologists (coefficient, -0.042; p < 0.001), and neuroradiologists (coefficient -0.010; p = 0.035). CONCLUSION/CONCLUSIONS:Horizontal occupational segregation exists in radiology with female radiologists devoting lower work effort to advanced imaging modalities. Further investigation is warranted to better understand the sources and downstream implications of such variation.

RATIONALE AND OBJECTIVES/OBJECTIVE:While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS/METHODS:US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS:Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION/CONCLUSIONS:The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.

PURPOSE/OBJECTIVE:The head-computed tomography (CT) exam code was recently identified by policy makers as having a potentially overvalued resource value units (RVU). A critical aspect in determining RVUs is the complexity of patients undergoing the service. This study evaluated the complexity of patients undergoing head-CT. METHODS:The 2017 Medicare PSPS Master File was used to identify the most common site for performing head-CT examinations. Given the most common location, the 5% Research Identifiable File, was then used to evaluate complexity of patients undergoing head CT on the same day as an emergency department (ED) visit based on the Evaluation & Management (E&M) "level" of these visits (1-least complex to 5-most complex patient) and the ICD-10 diagnosis coding associated with the billed head CT claims. RESULTS:56.1% of head CT examinations were performed in the ED. Seventy percent of noncontrast exams performed in the ED were ordered in the most complex patient encounters (level 5 E&M visits). The most common ICD-10 code for head-CT without intravenous contrast billed with a level 5 E&M visit was "dizziness and giddiness," and for head-CT without and with intravenous contrast was "headache." CONCLUSION/CONCLUSIONS:Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflects patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.