Applied Radiology

As the demand for imaging studies continues to escalate, the pool of qualified personnel to perform these exams is shrinking. A recent study commissioned by the American Hospital Association found that imaging technicians have the highest vacancy rate of all hospital staff members at 15.3%. ¹ In addition, 21% of hospitals reported "severe shortages" in radiology with vacancy rates above 20%. ¹ The need for qualified personnel is only expected to increase. The U.S. Bureau of Labor Statistics estimates the need for radiology technologists and technicians will continue to "grow faster than average" with an increased need of 21% to 35% by 2010. ² Yet, filling this gap is not easy. A study by the Massachusetts Medical Society found that more than 80% of respondents reported experiencing difficulty filling vacant positions for radiologists. ³ More alarming, 25% reported that they were forced to alter services and staffing patterns due to the physician shortage. ³

Recently, Hamid Tabatabaie, President and CEO of AMICAS, Inc., spoke with Applied Radiology on the subject of how technology can be used to help fill the growing manpower gap.

Applied Radiology : Just how serious is the manpower shortage in radiology?

Hamid Tabatabaie: It's pretty serious. Most typical workloads have continued to increase, and the supply of radiologists has not kept up. If anything, in certain cases, the supply has gone down. However, the volume of studies is the biggest culprit, with an aging population and more people getting exams during their lifetime. Scanners are becoming more sophisticated and, as a result, are used in a variety of new ways that they weren't used before. Physicians are relying on radiology imaging procedures more and more for more preventive [issues] and for treatment planning.

AR: How do you foresee the manpower trend continuing?

HT: If attention is not paid to this situation, there will continue to be a negative trend. I think that the situation will improve with new addition of college graduates who go into the lucrative radiology business. At the same time, not unlike other specialties, I see the addition of international graduates who are joining the workforce in the United States. There also seems to be a trend toward international recruits. Such recruits could actually be brought over to the States and others could be used for reading abroad. For some time now, large academic centers have been looking at how feasible it would be to have radiologists in India, South America, and perhaps other English-speaking countries to fill the demand remotely.

AR: How are the issues of licensing and credentialing being addressed in such situations?

HT: The licensing is no different from what is required here for teleradiology. The radiologist needs to be licensed in the state in which the patient has been examined. Therefore, the organization gets the foreign doctors to apply for and receive a license for the appropriate state.

The other issue is credentialing; that is, the person needs to be credentialed for whatever hospital that they are going to be reading for. The hospital, or whoever is contracting with this person for the reading, effectively has the liability. So, the group that decides to outsource the reading takes on the liability.

AR: How can technology be used to increase the efficiency of the radiologists that we do have?

HT: Look at the pure task that radiologists do: they read images, compare them to prior images, dictate reports, review reports, sign reports, and move on to the next case. So if you look at efficiency under those constraints, there are two sides that can be dealt with using technology. The first deals with receiving and viewing images--PACS. The other is voice dictation, voice recognition, and any automation that has to do with transcription.

In PACS, the type of PACS that lets the radiologist have access from anywhere has a great deal of promise. One way to stretch the supply to meet the demand is to have longer working hours for radiologists. One way to address that is to have access from home. If technology is used such that the radiologists' access from home is very similar to their access at work--so that the quality of images and the speed of access are the same--you have now effectively elongated the potential working hours. You also have cut back on the transportation time that it usually takes radiologists to go from one facility to the next.

Centralization of manpower is another promise of technology. Imagine that a group of radiologists is centrally located in a facility that is convenient to their lifestyle as well as well connected to the radiology departments of hospitals and imaging centers in the surrounding and remote areas. Then their efficiencies go up. This is not a hypothetical scenario; increasingly, large groups of radiologists are reading for large constituencies. For example, a large teaching hospital probably has from 40 to 80 radiologists. Conversely, you see groups of radiologists forming with 40 to 80 radiologists in the group, and they have reading responsibilities for as many as 15 hospitals.

AR: Do you see this as the wave of the future?

HT: I believe the trend will be interesting to watch. One solid trend that I think will continue is for hospitals to have off-hour and after-hour coverage by remote radiologists. Instead of depending on someone to drive back to the hospital at midnight to look at images in the emergency department, hospitals rely on radiologists to log on from home. They can be woken up to quickly take a look at images in a half hour. That's a big trend. That trend is also accompanied by the fact that people are going into that business specifically; they are forming the radiology group to do nothing other than read images at night for many hospitals.

Another trend that I see is groups reading for multiple facilities. I don't think we will ever replace the need for radiologists to be in the hospital for a great many cases, since much of the work that they do is consulting. It will be some time before technology gets to the point that you can effectively replace that portion of their responsibilities. But I do think that reading centrally is going to continue to be a trend.

AR: What efficiencies can be gained on the reporting side?

HT: We are seeing a great deal of attention paid to voice dictation and voice recognition, so the radiologist now doesn't have to rely on someone actually typing up the report that had been dictated on tape. But that, frankly, isn't what attracts radiologists. As far as they are concerned, that task was already being done by someone else. That is not creating more efficiency for them; it's creating more efficiency for the system as a whole.

There are other technologies that are coming on the scene, such as voice clips that are very much the same as what the radiologists traditionally did with audiotape. However, now the clips go into the computer and, lo and behold, at the other end someone in India is typing up their report and sending it back to them. Those technologies are being looked at very seriously by a lot of people, and a good many vendors are offering those types of things, including AMICAS.

AR: How will this use of technology affect the patient experience?

HT: If these efficiencies are taken advantage of, patient experience will continue to be enhanced. It used to be difficult to schedule a CT scan conveniently. Increasingly, there are more locally available facilities so patients don't have to drive very far, and scans are available on their time schedule. Secondarily the results are available very quickly. So the referring physician can make the next step right away.

AR: Will advances in technology transform the role of the radiologist?

HT: The technology is actually a very interesting duality for radiologists. Traditionally, radiologists have been very protective of their turf; they want to read everything before others get their hands on it. This technology causes them to think twice. For example, now there is no reason why OB/GYNs can't read their own ultrasounds, since as soon as the technologist is done with the patient, the ultrasound is available for viewing by the radiologist just as soon as it could be viewed by the OB/GYN. So one of the ways that the volume can be handled is by having some of the images go through new reading protocols; instead of radiologists reading it first, the specialist can read it.

In that same vein, the technology can help radiologists elevate their importance: There are three-dimensional (3D) images that create very good tools for surgical planning. Radiologists who go into interventional procedure are basically doing intervention-oriented surgical procedures under MRI or CT--basically image-guided small procedures and surgeries. Now the radiologist can take a look at a CT and can create these phenomenally important 3D models that can help determine how a patient should be treated. So radiologists are using these 3D procedures as an example of how the technology can escalate their importance in the chain of diagnosis.

AR: What new developments can we look forward to from AMICAS?

HT: To date, we are up to 135 installations. On the technology front, we are coming out with revisions all the time. One is a single viewer: no matter who the user is, he or she can use any viewer to have access to images. Once the user logs on, it provides each user with a personalized toolset. Also, this is a Web-based viewer so that it can be downloaded to a PC in an instant. It can also be upgraded this way. Once you set up your profile (how you like to set up your tools, the way you like to see head CTs, the way you like to see abdominal MRs, etc.), wherever you log on, you will have your own environment instantly.

The second thing is that we are coming out with a worklist that is just as customizable. Traditionally, PACS hasn't given you insight into what goes on after you place the order but before you receive the report. With this worklist, you will get that information. Because of the staff shortage, a lot of centralized radiologists are reading images, so this information is that much more valuable to them. They cannot walk up to somebody to find out what happened.