Michigan is feeling the effects of a nationwide radiologist shortage as the demand for medical imaging tests is rising, resulting in longer wait times for results that can run as high as two weeks and frustrating some patients.
Shortages of radiologists and radiology technicians to do x-rays and mris are affecting michigan hospitals and health systems, regardless of size or location, michigan hospital association ceo brian peters said.
“Demand for imaging services is increasing across the country, creating longer worklists for radiology staff at the same time the health care system is experiencing a workforce shortage in radiology,” peters said. “The combination of vacancies and increased demand can force imaging delays measured from days to upwards of two weeks.”
The country doesn’t have enough radiologists to handle the current volume of imaging demanded by patients. The high volume is due to an increased reliance on imaging for diagnosis and efficient patient care as well as an increasing number of patients, said dr. Eric rubin, chair of the american college of radiology’s commission on human resources.
“We have a rapidly increasing medicare population due to the baby boomers,” rubin said. “We (also) have a progressively decreasing number of people in this country who don’t have health insurance.”
Some patients in online forums have expressed frustration about delays in getting back test results. But others at two imaging facilities in metro detroit said they haven’t seen a delay in test results. Radiology tests scan the body for medical conditions such as fractures, infections and osteoporosis, among other issues.
But experts said getting more medical students into radiology and making use of artificial intelligence could help alleviate the shortage.
Over 1,800 vacant physician positions are currently posted on the american college of radiology’s job board. But demand for services is outstripping the number of available specialists. While the total number of active radiology and diagnostic radiology physicians only dropped around 1% between 2007 and 2021, the total number of u.S. Residents per active physician in the specialty grew nearly 10%, according to the association of american medical colleges.
Experts said advancing assistive technology and getting more medical students into radiology are the best ways to combat the shortage. But interest in the specialty has been declining. While the total number of diagnostic radiologists decreased 2.4% between 2016 and 2021, the number of first-year radiology residents and fellows dropped 7.2%, according to the aamc.
Metro detroit health systems such as corewell health and henry ford said radiology staffing has been down by as much as 10% of optimal levels, but have weathered the shortage by recruiting locally, offering more spots to educate radiology residents and giving existing radiologists the option to work at least partially from home.
“(the drop is) noticeable but not critical by any stretch,” said henry ford radiologist daniel myers. “We do a lot of volunteer, extra shifts and things like that. People are pitching in and we’ve been able to maintain patient care and patient turnaround on the reports, so there’s no exorbitantly long delays on getting your results.”
Remote work
Remote workstations allow radiologists at corewell health’s william beaumont hospital to work from home to keep turnaround times lower for patients in the emergency department, said clinical radiologist kiran nandalur. The goal is always to read scans like x-rays, magnetic resonance imagings (mris) and computed tomographies (cts) in the emergency department as quickly as possible, followed by inpatient scans and then outpatient ones.
“We were at one point pretty short on er radiologists,” said nandalur, who works on a team of roughly 100 radiologists. “But we were able to have our own radiologists … Pick up the slack.”
Some hospitals are seeking help from remote teleradiology groups to help cover the rising demand, nandalur said. However, neither henry ford nor corewell health contracts out for radiologist services.
The increased demand for radiology services creates a more competitive job market, peters said.
“Unfortunately, the supply of radiologists joining the field from residency is not meeting demand, nor keeping pace with retirements,” peters said. “Hospitals and health systems are also competing with practices offering remote-only positions, which allows michigan radiologists to work for out-of-state providers at higher rates.”
While teleradiology allows radiologists to access images from anywhere, it doesn’t decrease the volume of imaging that hospitals nationwide are dealing with, rubin said. Some radiologists also still have to be present on-site to perform procedures.
“When you use teleradiology you’re not necessarily creating efficiencies, but you’re making it easier to try to distribute the work that’s being done,” rubin said. “It’s not a solution to the problem. What it does do is it provides significant flexibility for radiologists.”
increasing residency spots
But interest in radiology appears to be increasing. Radiology is among the most competitive specialties and there is no shortage of interest from recently graduated physicians. Interventional radiology was among the top 10 competitive specialties measured by the percentage of positions filled during the 2024 national residency match program.
Megan moore, an oakland university william beaumont school of medicine graduate who is starting her residency at corewell health in royal oak this summer, said the specialty has become more competitive in the last few years. She was drawn to the field because of the wide variety of patient cases she’ll be exposed to and the prospect of consulting with a wide range of other specialty physicians.
“The shortage a lot of times comes back to the residency spots. … There are many people who are interested in radiology and sometimes just can’t get a spot in the field,” moore said.
The corewell health royal oak hospital graduates 10 radiology residents every year, up from seven in 2022, nandalur said. The increase of three still took several years to get but has been crucial to the hospital’s ability to combat the shortage, he added.
“That really helps us produce new radiologists to help the shortage,” nandalur said. “A lot of these people tend to stay. We try to really recruit people from michigan.”
The hospital can fund a fixed number of residency spots every year and chooses how to distribute them among the different specialties, he said.
“Radiology is such a busy area for our hospital that we need to increase the number of spots, and luckily the hospital understood,” nandalur said. “Fortunately for us, we’ve been a little ahead of the game compared to everyone else. That’s why we’ve not gotten hit by the shortages and wait times as much as everyone else.”
Henry ford similarly averages about nine first-year radiology residency spots each year. This amount has been static for years, myers said.
“You can’t just add training spots — they have to get funded,” myers said. “We are working internally to see if we can add some because we recognize that’s the pipeline to getting more radiologists out there.”
Henry ford has similarly adjusted its recruitment strategies to hire physicians who are trained there and may extend an offer of employment up to two years before they finish residency, he said.
“We’ve been very good at looking at internal talent, and growing them, and recruiting them,” myers said. “We’re trying to in return to increase the number of resident training slots that we have internally to kind of feed that pipeline.”
The number of new radiologists finishing training depends on the amount of money provided by the government to support those training models across the country, rubin said. When residency slots are assigned to specific institutions by the government, they are not assigned for any specific specialty, he added. Those decisions are left up to local teaching hospitals.
“Because there is a shortage of physicians across health care and they significantly push toward increasing the number of primary care physicians out there, you don’t generally see a significant increase in the number of radiologists,” rubin said.
A long-term solution to the shortage is to increase the number of radiologist trainees in the country, he said.
“But it takes six years at least to train a radiologist. So any type of … Critical mass implementation of increasing the number of radiologists in training is going to take, in our estimation, 10-15 years to have any significant impact,” rubin said.
technology solutions
More immediate solutions include looking into how artificial intelligence might supplement and help radiologists increase efficiency, rubin said. A technological revolution in imaging technology in the late 1990s and early 2000s allowed radiologists to produce a lot more studies and images, he added. Around that time imaging became fully digital.
“It’s those types of technological revolutions that historically made it so that radiologists could balance that volume increase,” rubin said. “Ai is not necessarily mature enough to get us there today, but we think that over the next couple of years, we’re going to start seeing evolutions in ai, not specifically for reading studies, but essentially to become our co-pilots and make us more efficient.”
The process of reading things like ct scans, x-rays and mris has become entirely digital and highly automated in the last 20 years, corewell health’s nandalur said.
“We have the technology that tells us, hey, this case needs to be read now,” nandalur said. “… Cases that need to be read urgently pop up right to the top.”
Lubomir hadjiyski, a university of michigan professor of radiology, uses ai models to analyze medical images and detect and characterize different kinds of cancer, monitor a patient’s response to treatment and spot abnormalities in different organs. Ai has been clinically deployed for several years, helping radiologists diagnose things like breast and lung cancers, hadjiyski said. They can function similarly to a second opinion and have not replaced radiologists themselves.
“The idea is to make sure they are not missing important cancers, or important abnormalities or lesions,” hadjiyski said.
Corewell health, for example, uses ai to screen for head bleeds. While the changes and developments may not seem big individually, as a whole they could help combat the radiologist shortage, nandular said.
“The program runs an initial screening for head bleeds — we already have that at several of our sites. So that alerts the radiologist like, hey, this scan that’s sitting on the list has a head bleed so that one can be read first,” nandular said. “We put our eyes on it, but they’ll put a second set of eyes on it with these artificial intelligence programs, so it kind of improves our overall accuracy, but also it kind of triages the cases.”
These types of systems can help emergency room doctors decide the order in which they review images, hadjiyski said.
“All the patients will be reviewed by the physicians, but they’re changing the order of the review,” hadjiyski said.
Researchers are always trying to make diagnoses more accurate, but she doesn’t anticipate ai replacing radiologists in the foreseeable future.
“There is much more information that we can receive or obtain from human interaction compared to the computer, which is still trained on specific tasks trained (with) specific data sets,” hadjiyski said.
Rubin agreed that ai is still in the embryonic stages of development.
“I think there’s this slightly irrational fear about artificial intelligence taking over,” henry ford’s myers said. “Ai is a tool. … Everyone’s using ai to help them be more efficient, but I just don’t see it really taking over autonomously.”
