Jonathan H. Sunshine

OBJECTIVE. The purpose of our study was to determine the types of imaging procedures performed by diagnostic radiology practices and the patterns and differences related to practice characteristics.MATERIALS AND METHODS. The American College of Radiology (ACR) surveyed 970 practices by mail, using a 65-item questionnaire, in 1999. A response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. Trends were explored by making comparisons with data from a 1991-1992 ACR study.RESULTS. Among the types of procedures studied, the highest percentage of multiradiologist diagnostic-radiology-only practices performed mammography (95%) and sonography (94%). (General conventional radiography and fluoroscopy were not studied.) The lowest percentage of these practices performed interventional procedures (69%) and MRI (77%). Solo practices showed less diversity in types of procedures performed than did multiradiologist practices and were a good dea...

Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.

OBJECTIVE. The purpose of this study is to present the latest information available on the shortage of diagnostic radiologists.MATERIALS AND METHODS. Four sources of information are available, and we present their data: first, the number of jobs for diagnostic radiologists advertised in Radiology and the American Journal of Roentgenology; second, vacancies in academic radiology departments as of July 1, 2003, ascertained by a survey of these departments; third, the ratio of job listings to job seekers at a major professional placement service, the Professional Bureau of the American College of Radiology (ACR); and fourth, diagnostic radiologists' self-reported workload burden, from the ACR's 2003 Survey of Diagnostic Radiologists.RESULTS. Jobs advertised in September–November 2003 (latest data available) were 28% fewer than in the same months of 2002. Vacancies per department averaged 3.9 in 2003, compared with 5.4 in 2001 and 5.1 in 2002. Listings per seeker were 1.4 in 2002 (latest data available) compa...

OBJECTIVE. We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices. MATERIALS AND METHODS. A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care. RESULTS. Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25–0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care–related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement. CONCLUSION. Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

OBJECTIVE. The basic characteristics of radiology practices in the United States are described. We defined radiology practices as diagnostic-radiology-only practices, either solo or multiradiologist practices. Findings were compared with those from other data sources. MATERIALS AND METHODS. In May 1999, the American College of Radiology surveyed 970 practices by mail using a 65-item questionnaire. A final response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. RESULTS. Approximately 4400 radiology practices existed in the country; 39% were located in nonmetropolitan or rural areas. The greatest percentage of practices (85%) was private nonacademic radiology practices. The greatest percentage of practices (43%) served only hospitals. However, solo practices were particularly likely (p ≤ 0.01) to serve only nonhospital sites. Of all multiradiologist practices, 87% were completely owned by their members, but approximately two thirds of academic multiradiologist practices had outside owners. Seventy percent of multiradiologist practices interpreted images from outside clinics or groups; these averaged 3.2 outside clinics or groups for which they interpreted images. CONCLUSION. The basic characteristics of radiology practices in 1999 are described. Good agreement was seen with findings obtained from other data sources.

To determine whether data from a professional society placement service--the Professional Bureau of the American College of Radiology--are a valid measure of the employment market. For the United States from 1990 to 1998, the authors compared three placement service measures-the annual number of job listings, job seekers, and listings per seeker-with two presumably valid measures of the employment market-annual total jobs available (which was ascertained from surveys of hiring) and radiologist median income relative to the all-physician median. For the comparisons, both graphic displays of the data and correlation were used. In graphs, patterns of change were similar. The correlation of job listings, which measure demand, with total jobs, which also measure demand, was 0.84 (P =.04). The correlation of (a) job seekers, a measure of supply, and (b) listings per seeker, which involve both supply and demand, with total jobs was substantial but lower: 0.58 (P =.23) and 0.76 (P =.08), respectively. Correlation of the three placement service measures with relative income, which presumably depends on both supply and demand, was 0.80-0.88 (P <.05 for each measure). The statistical significance levels of the correlations and the pattern of findings--namely, stronger correlations among measures of the same aspect of the employment market--indicate that these placement service data are valid and reasonably accurate measures of the employment market.

OBJECTIVE. We sought to describe radiologists and their practices, emphasizing trends in retirement age, practice size, and perceived workload burden. MATERIALS AND METHODS. In spring 2000, we surveyed 3,027 randomly selected radiologists by mail, of whom 74% responded. We weighted responses to make answers representative of all radiologists and compared findings with a similar 1995 survey. RESULTS. Thirty percent of radiologists age 65-69 were working full-time; 21% were working part-time. Overall, the full-time equivalency of radiologists age 55-74 was 67.6%, not significantly different from 1995. If current patterns of retirement and production of graduates continue, the workforce will grow at a rate of approximately 2% annually. Fifty-one percent of radiologists said that recognizing that income depends largely on work done, they had “much too much work” or “somewhat too much work”; 5% reported “somewhat too little work” or “much too little work.” Six percent of posttraining professionally active radiologists were in solo practice, down from 8% in 1995; 15% were in two-to-four-radiologists groups, down from 17%; and 38% were in groups of 15 or more, up from 30%. Sixteen percent of posttraining professionally active radiologists were women. The percentage was highest (29%) for those younger than age 35 but was lower (22%) among trainees. CONCLUSION. The findings of excess work are further evidence of a radiologist shortage. However, contrary to surveys of groups that are hiring, we found minimal evidence of earlier retirement. Nonetheless, workload currently is increasing faster than the workforce is likely to grow, so the shortage will probably intensify. The typical number of radiologists in a practice is increasing, but slowly.

OBJECTIVE. We sought to determine the 1998 hiring activities of physician practices with respect to diagnostic radiologists. MATERIALS AND METHODS. A survey was mailed to a sample of 970 radiology practices in the spring through fall of 1999; 73.0% responded. Responses were weighted to represent all practices in the United States providing diagnostic radiology services. Findings were compared with results of similar surveys from previous years. RESULTS. In 1998, multiradiologist groups sought to hire 2299 (±148 [standard error]) diagnostic radiologists, an increase of 20% from 1977. Positions offered in 1998 were split almost equally between expansion positions and replacements for those who had left a practice. Another 422 (±58) positions had been vacated that practices did not seek to refill. In 1998, 621 (±57) diagnostic radiologists left active practice, which is more than the usual number of approximately 400 annually but less than the approximately 800 of 1996 and 1997. There was no significant association between hiring activity and the self-perceived effect of managed care on a group. CONCLUSION. The pace of hiring and turnover of diagnostic radiologists increased in 1998. Positions available continue to exceed radiologists available to fill them; the excess was approximately 330 positions, which is not significantly different from the excess reported for 1997, but is higher than the (not statistically significant) net shortfall of 51 positions estimated for 1996.