Understanding and Revitalizing the Radiology Workforce: RSNA Take-Aways to Enact Change for a Bright Future

On Wednesday afternoon at RSNA, Jocelyn Chertoff, MD, MS, chair of the department of radiology at Dartmouth Hitchcock Medical Center, tackled a challenging matter: “Understanding and Revitalizing the Radiology Workforce.” With complex and significant supply and demand mismatches plaguing the specialty’s providers and healthcare at large nationwide, this was a daunting topic. Yet her goal was that the audience would find the presentation “interesting, insightful, and inspirational.” Dr Chertoff achieved this with the right dose of candor, matter-of-factness, and optimism, hard evidence blended with all-too-familiar anecdotes, and a clear understanding of the pressures radiologists are experiencing.

Dr Chertoff began her talk by sharing some sobering predictions: in 2030, the world is facing a shortage of about 10 million healthcare workers. The Association of American Medical Colleges (AAMC) predicts that by 2034, the U.S. will be short 124,000 physicians. Of that, by 2033, the group of radiologists, pathologists, and psychiatrists will face shortages between 17,000 and 42,000 physicians.

“This is affecting us now and will continue to affect us,” Dr Chertoff said, noting that the president of the American Medical Association (AMA) recently went before Congress for help with this urgent workforce crisis. He pinpointed administrative burden, burnout, attacks on science, consolidation, and the Medicare payment system as factors.

Contributing to workforce shortages are the “7 Ps”:

• Population growth: The U.S. will grow about 90 million people between now and 2050.
• Population aging: The U.S. will have more seniors than children for the first time in history, with much greater healthcare needs.
• Provider aging: Thirty percent of physicians in active practice are 60 and older.
• Provider burnout: The public health crisis was in effect prior to the pandemic, and has worsened.
• Pervasive ill health: Six of 10 adults have a chronic medical condition and 40% have two or more.
• Pipeline problems: The federal funding was capped in 1997 and it’s been very limited, particularly for specialists.
• Practice styles: A lot of physicians have preferences that include part-time work, locum tenens, and other arrangements so there are reduced overall FTEs.

Further, the COVID-19 pandemic has had a significant effect on the workforce. In the first year of the pandemic, 2.2 million women left workforce, and 11 million workers quit their jobs in spring of 2021. While some of them have come back, a “great resignation” indeed occurred, Dr Chertoff confirmed, noting it will never be the same. Further, in 2022, 29% of U.S. radiologists were 65 or older, while only 10% of radiologists were under age 40.

Dr Chertoff noted other challenges impacting the radiology workforce, documented in literature, including commoditization of radiology, the RVU production model as a driver, salaries not keeping up with inflation, physicians’ vulnerability to overwork, burnout, financial and moral pressure, and harassment in the workplace. Many of these were exacerbated by the pandemic, she explained.

“What’s on fire right now in terms of strength and opportunities? The answer is very clear, our workforce. So what we really need to do is look at this moment and see how we can turn this into an opportunity because we’re on fire,” Dr Chertoff said.

First, the workforce must consider strategies for retention due to changing work environments, pressure on productivity, and shrinking reimbursements. Telling employees to “just cheer up,” throwing money at them, making promises (or threats), and repeatedly doing the same things that don’t work are the wrong routes to go, she said. More helpful are increased delegation of authority and autonomy, and encouragement of innovation.

“These are highly skilled, highly educated people. Why wouldn’t you let them use their judgment to make the right decisions?” Dr Chertoff asked. “Reward good work, and most importantly, encourage innovation.”

Regarding recruitment strategies, recruiting promising learners and creating a departmental brand in which the whole department is engaged is helpful, but Dr Chertoff acknowledges “we’re all trying to recruit the most promising learners, and we don’t have enough learners. We’re all trying to put our best foot forward, but we’re poaching from each other….there aren’t enough radiologists and we aren’t going to be able to solve this problem using an incremental approach.”

Dr Chertoff also explored potential strategies for workforce revitalization, including a vision of Vanderbilt’s Reed Omary, MD, MS, acknowledging the “strength of our ability to communicate and the power of our profession.” Engage with climate change, explore new ideas, harvest data for new insights, invest in growth, seek diversity, and provide opportunities for development and change. Radiology needs to think about proactively investing in positive relationships and communities that foster creativity since the current approach, Dr Chertoff said, is actually “stifling innovation.”

“The push for eliminating variation, while it’s extremely important, you can’t go too far because that will be at the expense of creativity,” she cautioned. “If everything has to be done exactly by the book, you are going to miss that ‘happy happenstance’ that leads to inspiration. So there has to be time, tolerance, and resources for creativity.”

Dr Chertoff also addressed the perils of technology and their effect on the workforce. Workplaces cannot be “recreated” on screens via remote work. When applying artificial intelligence (AI), radiology leaders should think about how AI can be used as a tool to help meet departmental needs like improving connectivity and eliminating unnecessary work, not simply add it to the mix based on its known attributes. Technology will continue to help change and streamline the work, she said, emphasizing the importance of having a human in the loop so healthcare providers are facilitating and monitoring the work the technology is performing.

“Clicks drive you insane. Invest in technology to give time back to workers,” she added.

And qualities like truth, passion, fairness, and creativity can only be engendered by humans.

Dr Chertoff suggested the specialty considers how they can make the most of all workers, regardless of their degree, so each contributor can work at the top of their licenses. Those without college degrees are becoming excluded from jobs, power and social esteem, and their longevity is decreasing. A range of educational qualifications fit different jobs.

“We have to be more open to letting everyone do their best work,” Dr Chertoff said, noting job creation, design, and mobility lead to new opportunities and often more efficient processes. “[Some employees] can do more than we allow them to do.”

As for executing on these must-needed changes in the workforce, Dr Chertoff recommends a kind of systems engineering approach, establishing a clear goal, and envisioning future success.

“Imagine being interviewed, and go backwards step by step and identify the major milestones you needed to achieve to get there,” she advised, which helps with planning the to-do’s required to meet the goal.

Dr Chertoff also shared a visual that demonstrated the effects of stress—as an explosion—versus microstress, presenting more as erosion. The latter wears radiologists down; simple, minor, but endless irritations “drain your capacity to get work done” and “deplete your emotional reserves,” she said, citing management responsibilities, confrontational conversations, lack of trust in the network, and political maneuvering as examples. Microstresses can also challenge one’s identity with mismatched goals, attacks on self-confidence, damaging disruptions, and expectations that threaten work-life balance in a system that can be difficult to navigate.

“The system does not plan or allow for meals or breaks or illness so when you get sick you feel guilty not going to work, or when you eat your meal you eat it at your computer so you’re still working… You have to get away from it,” she said, adding that eight hours of education is required to renew DEA and more than eight hours for annual e-learning, explaining “there’s no time to do it.”

At a time when incivility in the workplace is on the rise, Dr Chertoff pointed out that a negative interaction has five times the impact of a positive one, which can zap energy. She suggested pushing back, managing technology, adjusting relationships, and rising above negativity by living a multidimensional life outside work.

“We need to make kindness, generosity, and civility important. If you care about it, the people around you will care about it.”

To improve morale—and maybe even efficiencies—“just say yes to [employees’] new ideas,” she recommended, whether it’s a flexible job schedule, job sharing opportunity, or new work model. “You might discover something fantastic.”

Healthcare leaders have to rebuild and restore trust with employees, Dr Chertoff said, noting that workers at high trust companies experience higher productivity, more engagement, and less burnout. They can do so by listening to clinician pain points, and trying to address them.

Dr Chertoff concluded with a quote from her favorite philosopher, Dr. Seuss.

“Unless someone like you cares a whole awful lot, nothing is going to get better. It's not.”