It’s hard to believe today, but it’s true. Less than a decade ago, radiology was considered the cul de sac of medical careers. Road closed. Do not enter. People believed the signs and took the detours.

Skip ahead to now. Radiology is back on the map, big time. Modern technology is a wondrous thing, amply illustrated in the way MR and CT use has increased exponentially every year since their introduction. Radiology centers bloom everywhere like weeds while their want-ads clog the Web, radiology journals and résumé boards at tradeshows and clinical meetings. And as the price of ultrasound has fallen, it has become more widely available in smaller cities and rural areas — places where finding trained sonographers is like pulling teeth. In short, the proliferation of promising new modalities generated by modern technological wizardry has dazzlingly outpaced the manpower available to utilize and maintain it.

Demand for imaging services is staggering, but the human resources highway has bypassed radiology. What happened?

Before you read the answers, check out some scary stats. The American Registry of Radiologic Technologists (ARRT of St. Paul, Minn.) reports that 216,106 radiologic technologists (RTs) were registered in the U.S. in 2002, while the American Hospital Association (Chicago) reported a 15.3-percent vacancy rate. The U.S. Bureau of Labor Statistics predicted the country will need 75,000 more RTs in 2010 than it did in 2000. Why? Because the volume of radiologic exams will explode from 350 million now to 450 million in 2010, says the Radiological Society of North America (RSNA of Oak Brook, Ill.).

RTs average between 800 and 3,300 exams per year depending upon specialty, estimates the American Healthcare Radiology Administrators (Sudbury, Mass.). Given those figures, 291,000 RTs might be enough to plug the gap. If you can find them.

The news about radiologists isn’t any cheerier. (But remember the glut reported a decade ago?) The American College of Radiology (Philadelphia) estimated there were already 278 openings for radiologists in the U.S. back in 1997; the RSNA subsequently reported a 7-percent decline in radiology residencies between 1995 and 2000.

Meanwhile, the inevitable has happened. Baby Boomers will be retiring in vast numbers through 2028, 78 million of them in 2010 alone. More than half of the RTs currently working were born before 1960. As their own retirement deflates the workforce, they’ll be overwhelming Medicare. In other words, lots more people will be needing imaging simultaneously as lots of people who do the imaging retire. So if you think you’ll ever need radiologic services, better take a number now.

Wanted: warm bodies, degree a plus
The current shortage first appeared on radar screens about five years ago. Everyone agrees on that. As for the reasons why, take your pick.

A spate of recent industry surveys cite mass exodus, offering the following reasons: union walkouts, lack of opportunity for advancement, lack of appreciation, abuse from patients, increased litigation over missed tumors, prohibitive housing prices in high cost-of-living areas, better salaries at competing facilities, and retirement (the rate has doubled since 1997, when stock market gains facilitated early departures). Faculty who train radiologists are leaving academia for more lucrative private practice. Full-timers are quitting staff jobs to temp for double their old salaries. A newish invention, the walk-in clinic, is draining hospital staff with the promise of regular office hours and little or no holiday or on-call work.

A radiologist glut from 1995-1996 put some doctors out of work. Many were obliged to relocate, extend fellowships, or become PACS consultants. Decreases in Medicare conversion factors and reimbursements forced many facilities to choose having enough equipment, or having modern equipment, over having enough personnel. Many radiologists relocated to states where payments were more reasonable. Convinced that radiology was a dead end, med students bagged it.

Both students and schooling for them started to disappear. Restrictive training quotas established by the Balanced Budget Act of 1997 caused many med students to pursue other specialties. The ARRT reported a decrease in first-time RT examinees from 10,330 in 1995 to 7,149 in 2000 for radiography, and from 941 to 399 over the same period for radiation therapy. The American Society of Radiologic Technologists (ASRT of Albuquerque, N.M.) reports that since 1994, the number of radiography schools accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT of Chicago) declined from 692 to 583, and JRCERT-accredited radiation therapy programs declined from 125 to 69.

By the time the glut became a famine, funding cuts had eliminated many radiologist training slots. Robert Stanley, M.D., past president of the American Roentgen Ray Society (ARRS of Leesburg, Va.), is a professor and chairman of the department of radiology at the University of Alabama at Birmingham (UAB). “In our program,” he says, “even though we are accredited by the ACGME [Accreditation Council for Graduate Medical Education, Chicago] for 24 slots, the number we had from the particular year [the government] used as their sample was 21. All of a sudden, we had three that were not funded for graduate medical education.”

John Cronan, M.D., chairman of diagnostic imaging at Brown University in Providence, R.I., says, “When Medicare put a limit on the training spots, they froze the number of training positions.” As a result, “this is the most competitive position coming out of medical schools right now. There are probably three or four kids applying for every radiology spot.”

The ARRS reported that some 200 American med school grads could not secure radiology training positions in 2000. Brown’s diagnostic imaging department is affiliated with four of Rhode Island’s largest hospitals. Cronan says graduates “have offered to do a residency for free. But it’s illegal.”

Both Cronan and Stanley feel the training cap, cloaked in cost-saving rhetoric by the government, was really a deliberate ploy by Medicare to steer med students away from specialization and into primary care. For the Feds, it was a classic lesson in being careful about what you wish for, because you might get it.

“I estimate there are more than 2,000 openings for radiologists in the country right now,” says Cronan. “MR and CT are growing at 12 to 15 percent a year. You have 840 people finishing training in a year. To keep pace with the status quo demand and the retirements, you’d probably need over 1,000 people a year. Then with the growth, there are probably 1,200 to 1,400 people you need a year as radiologists. So the shortage is immense.”

Big $$$, start today
Technologists are arguably tougher to find and keep than radiologists, for a variety of reasons. One is attrition. A recent ASRT survey showed that 21.7 percent of RT students dropped out before graduation. Other reasons RT schools aren’t full include the unavailability of night or distance-learning courses and the siren call of more glamorous, or at least less dicey, careers.

Cronan says, “We have a school [at Brown]. We can accept up to 18 people a year. We haven’t had, for the last five years, more than 12 kids in the school a year.”

To find out why, Cronan consulted a chief guidance counselor from a major public education system. After completing a two-year program, Cronan explained to him, students can get a $26,000 job right away, rake in $100,000 if they want to work overtime, and train for an upgrade to MR or CT where they can earn even more. What’s not to like?

Cronan says the counselor’s reply to him was, “‘But you get to work the second or third shift for the first five years, and you get to work every Christmas or Thanksgiving for the next five years, and you get to be exposed to blood and AIDS. Now tell me again why you think you’re having a problem getting kids.’”

The difficulty in finding and retaining RTs was actually exacerbated, rather than helped, by skyrocketing remuneration for their shortage-era services. Salaries have shot up 20 percent since 1997, encouraging rampant job hopping.

Cronan says, “The Boston hospitals have found out what our salary scale is. They’ve given $5,000 signing bonuses plus $5 more an hour to [hire away] our CT or MR technologists. They have no qualms about calling directly and asking to speak to technologists.”

Registered CT and MR technologists now average nearly $54,000 per year. Newly minted RTs naturally chase those jobs, which pay nearly twice as much as x-ray. When positions that include training open in CT and MR, x-ray techs make a beeline for them too, abandoning jobs that have no pool of wanna-bees eager to step in.

Many facilities with staff shortages have been forced to extend their hours and demand more overtime from their already-overworked personnel. In a 2001 ASRT member survey, weary respondents duly reported skipped meals and breaks, exhaustion, smashed fingers, bumped heads, needle sticks, and dropped patients.

Do the hustle
The competition for radiologists makes the RT scramble look like a sale at Macy’s. Entry-level radiologist salaries in some areas have exceeded those of established practices, particularly in less desirable places that require more leverage to attract talent — say, $300,000 and up. The median income is $415,000, and superstars can earn $800,000, according to a survey by Allied Physicians, Inc. of Rehoboth Beach, Del. The SalaryScan survey published in June by the radiology Web site AuntMinnie.com and CompHealth Inc., a Salt Lake City recruiting firm, states the average base salary of U.S. radiologists is $267,466, with bonuses averaging $88,450 and merit increases in the 8 percent to 10 percent range.

When calculating how much doctors will cost to hire, don’t forget to add finders’ fees and other little extras. Cronan says headhunters want $40,000 to place radiologists in the Providence area. Benefits packages now include such goodies as insurance coverage, shorter waits for partnerships, and paid release time to work at other jobs.

Healthcare consultants Merritt, Hawkins and Associates (Irving, Texas) claim that in 2001, 44 percent of residents in medical specialties received 26 or more job solicitations during the course of their training, for an average salary of $271,000. The overall result of too few candidates chasing skyrocketing compensation is vacancies that typically go begging for months. Cronan says, “We’re having a heck of a time keeping our spots filled.”

Brown has its own residency program and used to be able to count on radiologists sticking around for up to six years. Now, however, “People are leaving immediately,” says Cronan. “For the first time in my memory of the last 20 years, people are skipping their fellowship training. I’ve had many people reject my job offers this year.” He now spends a third of his time recruiting, up from 5 percent two years ago.

Experience required, call now
Things are no better in engineering departments than they are in clinics. Michael Harris, B.S.E.E., assistant administrator and head of radiology physics and engineering at Johns Hopkins Hospital in Baltimore, manages the technology caretakers there. He, too, has shortage troubles.

“The big difficulty is being able to grow people into positions,” he says. “I have very few entry-level positions because of the high-intensity nature of our department and of medical imaging equipment. Usually we’re looking for staff with three to four years’ experience. It takes, sometimes, experience of the better of eight years for someone to be effective in dealing with [medical imaging] equipment service problems. I look for engineers preferably with a bachelor’s degree and at least five to six years’ experience for handling the more sophisticated devices, such as special procedure labs in our cardiovascular division, MRI scanners, CT scanners, also ultrasound systems.” In other words, Harris doesn’t have the luxury of hiring scoobies straight out of school, and that narrows his already-limited resource pool.

Things are rough in IT, too. “The toughest thing to find is people who have experience in PACS and telemedicine, people who have good training and understanding of the software that’s involved with all the systems,” says Paul Stevens of The Medical Connection, a Philadelphia headhunting firm. “A lot of people understand how the hardware works, but quite often they’re limited in understanding the software.”

Harris says he was recently given the OK to offer certain types of engineers a $3,000 hiring bonus. Sign-on incentives for all radiology-related positions have reached nosebleed levels, reportedly averaging $2,000 to $10,000 for dosimetrists and radiation therapists, and $25,000 for radiologists.

Stevens says, “The most generous perk I’ve heard of is a company offering a $10,000 start-up bonus, selling the candidate’s home, and helping with the purchase of a new home.”

What’s a hospital to do?
“There are two solutions.” You need more technologists, says Cronan, and you need to hook them early. Brown used to aim its marketing at high school seniors, but the school counselor Cronan consulted told him that was too late. “High school seniors are either college bound, or they’ve made up their minds about something else,” Cronan says. Now Brown hosts career enlightenment events for eighth graders.

Another tack is drawing from internal resources. The University of Alabama, among others, is repurposing staff technologists into radiologist assistants (or RAs, also known as RPAs — radiology practitioner assistants), thereby freeing doctors to spend more time reading films and less time on tasks that can be delegated to pararadiologists. The difference between RTs and RAs is that RAs perform radiological procedures (supervised by a radiologist) and receive higher pay ($65,000 to $72,000).

In UAB’s program, four CT and x-ray staff technologists were retrained as RAs in neuro and body CT and in GI fluoro. Their tasks, says Stanley, include “explaining procedures to the patients, getting the patient’s history, and gathering up the old film or making sure, if they’re in a PACS environment, that the prior studies were pulled from the archives so that they’re ready to be viewed on the console.”

UAB’s first CT RA was such a hit, the school’s other imaging departments demanded their own. Stanley says his x-ray RAs’ air contrast barium studies are better than the residents’.

While UAB’s RA boot camp is still a work in progress, Weber State University (Ogden, Utah) offers a certified RPA training program. Its grads are much in demand. For more information, visit: http://weber.edu/chp/programs/radsci.asp?http://weber.edu/radsci/~Main (Click “Academic Programs,” then “Radiology Practitioner Assistant.”)

Musical chairs
Once you’ve actually got radiology staff, how do you keep them? According to a recent study by the American Medical Association (Chicago, Ill.), all you have to do is give them conference and seminar subsidies, tuition reimbursement, managerial training, and support for degree programs. Or, you can try Stanley’s plan: Offer residents and fellows free loans to stay put.

Recently four UAB candidates were selected according to their teaching aptitude and offered loans averaging double their salaries. The loans will be forgiven if the recipients remain on the faculty for two or three years.

For now, until there are enough employees to go around, technology will have to pick up the slack. Historically, of course, machines have humbled many an overpaid human, automating countless skilled laborers right out of a job. Just ask any unemployed film librarian.

Stanley named PACS as his favorite labor-saving device. He says it enables radiologists to be in many places at once, thereby optimizing their services and making more of the staff you’ve got. Plus, he says, “there’s a speed thing that cuts down on the number of phone calls and inquiries about what somebody thought of a particular x-ray. And voice recognition technology is just a remarkable step forward, as far as efficiency,” he adds, foreshadowing the demise of the flesh-and-bones transcriptionist.

Can RoboDoc be far behind? We’ll have to wait and see.