In January 2020, as cases of Covid-19 were proliferating across the globe, Eric Rubin, MD, began his first term as chair of the ACR Human Resources Commission. The commission has surveyed practice leaders annually since 2012, but that year the commission did something it had never done before—it paused.

Dr. Rubin, an abdominal imaging radiologist with Southeast Radiology, a 21-radiologist practice based in Media, PA, and member of Strategic Radiology, saw an opportunity for the commission to stop, look closely at the previous ACR Workforce Survey tool, and think about how it could be revised with the objective of providing more actionable insight into workforce trends.

“If you don't understand why the workforce is performing the way that it is, it's going to be very, very hard to be predictive and to be understanding of the way that things might go in the future,” explained Dr. Rubin. “To us, the most important goal is not necessarily what has happened in the past year or couple of years, but to better understand where the workforce might be going, so that we can be predictive and try to begin to make adjustments as needed.”

Seeking the Why

As a result, the original survey—which queried practice leaders about the composition of their present workforce by subspecialty and the numbers and types of subspecialists and mid-levels hired and anticipated to be hired—was completely revamped and significantly broadened to include rank-and-file radiologists. While the 2018 report on the workforce survey had 600 responses, the 2022 survey had 2,000 responses, data that is weighted to be representative demographically of the U.S. radiologist universe.

On a professional and personal level, Dr. Rubin was motivated by a deep love of radiology, great respect for what the ACR does, and a keen interest in meeting the needs of future-generation radiologists. “We need to be ready for the radiologists not just of today but of the future in order to sustain our profession as it should be because it's a great profession,” he said. “What we do in a day is great. I really love my job.”

Dr. Rubin, along with Dominick Parris and Mary Jo Tarrant—the two ACR staff members who work most closely with the commission—will participate in a panel discussion on the changing workforce at the upcoming Strategic Radiology Fall Summit on September 30. We talked with Dr. Rubin about how the survey changed and what the Commission hopes to accomplish. Excerpts from that interview and a conclusion follow.

Question: What are the most significant ways that the survey has changed?

Dr. Rubin: One very important section that we added was a section specific to rank-and-file radiologists. We continued with the traditional approach, which was to ask questions of decision makers, but we also added questions of rank-and-file radiologists so that we could understand what motivates and drives radiologists in practices and where they see themselves in the future. We began to look at workforce needs, both from the perspective of a practice leader but also the needs of the individual radiologists.

We also wanted to investigate the diversity of the radiology workforce, and we found that there is a growing gender and ethnic diversity amongst our younger cohorts of radiologists. That's very, very important, because we as a profession and the ACR need to understand that what we provide to these radiologists may need to be different based on their drivers and motivators than previous generations that demonstrated a different level of diversity. We're also seeing trends in generational differences: our younger radiologists have very, very different drivers and motivators, with respect to what they find important, both in their professional goals and with respect to their goals for work-life balance.

Work-life balance has become a very important factor in the way that people make decisions about where they want to work and how they want to work. Many people, not just the younger generations, believe that it might be better to work-to-live rather than live-to-work. We're seeing those changes.

Papers have been published already or accepted on diversity in radiology, and they are forthcoming. We have submitted and we're waiting for print publication of various other papers. The Workforce Survey is no longer generating just one large paper. The new survey generates a lot of data that can be utilized for multiple, different reports and different types of perspectives about the radiology workforce.

Question: Aside from age, gender, and ethnicity, what other workforce characteristics does the survey explore?

Dr. Rubin: In 2022, we started asking questions about salary and benefits and the use of artificial intelligence. We've got some special focuses on pediatrics and radiation oncology and are expanding into different areas that have been looked at to some extent in the past. We’re trying to evolve the survey to be something that gives a lot of different perspectives on many different issues in radiology so that the data that's available is not exclusively for people who are hiring, but for all radiologists to look at and understand what their profession looks like.

Question: Were there any surprises in the results of the current survey?

Dr. Rubin: Yes, there were. Here's what's surprising to me: When you look at these surveys, even though we added dimension, a lot of the data looked relatively stable over time. That was a surprise and a concern, because when we walk out the door, people say, "We have a major radiologist workforce shortage in this country." I've got data from a workforce survey that doesn't raise that red flag, it doesn’t say something's really, really, wrong here.

Digging Deeper

That curious realization led to a deeper inquiry by the Human Resources Commission. Dr. Rubin asked Mr. Parris to gather data available from a variety of sources in the public domain, including the number of radiologists that are practicing in the U.S.; current Medicare recipients now and projected through 2030; the number of radiology patients and radiological procedures performed annually; and the number of medical students matching in radiology. They also collected data on the number of internal medicine physicians, surgeons, and family practice physicians.

“We took all of that data, and started to calculate what the radiologist workforce looks like now relative to need,” he noted. “We backed up and started in 2017, looking at trends to better understand what radiology is relative to other specialties. We are trying to make projections through 2030 and beyond about how many radiologists there will be in this country, and how many radiologists per patient we expect to have.”

All of this is part of the work of the Human Resources Commission in response to the radiologist market. “There is a radiologist workforce shortage in this country, but the question is why?” he asked. “Once we figure out why it happened and what we're dealing with, we have to try to decide how we can mitigate the workforce shortage and how we can repair that workforce shortage.”

Dr. Rubin acknowledged that the radiologist workforce is cyclical, with time of plenty, scarcity, and times of just enough radiologists. “We want to try to begin to make projections, so we can adequately provide care for our patients,” he said.  “That's what we're going to be discussing at the SR meeting.”

Dr. Rubin, along with Mr. Parris and Ms. Tarrant, will solicit feedback from private practice radiologists about various interventions that could be applied to help mitigate the shortage, an exercise that will be repeated at the ACR Board of Chancellors meeting in Utah in early October, at the Council Steering Committee, and among ACR staff.

“What I can promise, is that Strategic Radiology and the ACR cannot solve the workforce shortage,” he noted. “But we can look at what we can do to at least try to nudge it in the right direction. The ACR has resources and a voice that might be able to help to evolve the specialty in a manner that at least begins to smooth this out and make things a little bit better so that it doesn't get worse.”