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%.
In addition, 21% of hospitals reported "severe shortages" in
radiology with vacancy rates above 20%.
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.
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.
More alarming, 25% reported that they were forced to alter services
and staffing patterns due to the physician shortage.
Recently, Hamid Tabatabaie, President and CEO of AMICAS, Inc.,
on the subject of how technology can be used to help fill the
growing manpower gap.
Just how serious is the manpower shortage in radiology?
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.
How do you foresee the manpower trend continuing?
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
How are the issues of licensing and credentialing being addressed
in such situations?
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
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
How can technology be used to increase the efficiency of the
radiologists that we do have?
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.
Do you see this as the wave of the future?
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.
What efficiencies can be gained on the reporting side?
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,
How will this use of technology affect the patient experience?
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.
Will advances in technology transform the role of the
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.
What new developments can we look forward to from AMICAS?
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