1998 Australian radiology workforce report

The 1998 Australian Radiologist Workforce Survey findings form the basis of the present report, prepared by the Workforce Committee of the Royal Australian and New Zealand College of Radiologists (RANZCR). A more detailed report can be accessed through the RANZCR web site (http:@www.ranzcr.edu.au). This follows similar previously published reports by the Workforce Committee in the 1990s. The issues of radiologist workforce supply and demand are examined, and benchmarks again reviewed. One of the conclusions of the present report is a possible upcoming shortage of radiologists in Australia, due to several factors, including a possible increase in the attrition rate of an ageing radiologist population, increasing female participation in the workforce, and increasing medical imaging utilization rates. In comparison with other Organization for Economic Cooperation and Development (OECD) nations, Australia had a mid-range supply of radiologists, and also medical imaging utilization, although there has been an increase in the latter. Australian radiologist annual workloads appear to be increasing.     

Interpreting urgent brain CT scans: Does review by a radiology trainee make a difference in accuracy?

An urgent brain CT scan is now commonly performed on patients presenting to hospital emergency departments for a wide variety of indications. At most institutions in Australia, such scans are reviewed immediately by an on-call radiologist, who is usually an accredited registrar. The value of the trainee radiologist in such a setting is unclear. In the present study, the rate of abnormal findings in a random sample of 100 brain CT scans performed on hospital patients is reviewed and the accuracy of detection of potentially urgent lesions is compared between three junior clinicians, an accredited radiology registrar and a junior radiographer, using the final radiological report as the standard of reference. At least one potentially urgent abnormality in 25% of the patients scanned was found. The RANZCR trainee recorded a significantly higher sensitivity compared to the other readers. It is concluded that an urgent brain CT is of greater value as a screening test if a contemporaneous radiological review is made available, and the implications this may have on current imaging practices are briefly considered.     

The Service Review Committee: Royal College of Radiologists. Philosophy, role, and lessons to be learned

The Service Review Committee (SRC) was established by the Board of the Faculty of Clinical Radiology in 2000. At the time, the RCR identified a clear need to respond appropriately and swiftly to requests for review of service provision in clinical radiology departments where trusts were concerned about standards or performance issues. It was recognized by the College that the poorly performing radiologist is often part of a department that is itself dysfunctional, and that sub-optimal performance may often reflect inadequate management, lack of support, overwhelming workload, or inadequate facilities. Following the completion of a range of service reviews during its first 6 years, the SRC recognized that among the reviews there were recurring themes and causes for poorly functioning departments. The committee felt it appropriate to share these with the wider radiological community. In doing so, it is hoped that other departments may recognize their own problems at an early stage and take appropriate steps to prevent any escalation of difficulties.     

Productivity of radiologists: estimates based on analysis of relative value units

Analysis of relative value units (RVUs) was used to quantify patient-care productivity of radiologists in 19 multispecialty group practices and to determine how productivity is affected by certain characteristics of the practices. The RVUs used in this study are the professional component RVUs developed by the American College of Radiology and the Health Care Financing Administration and published as the Radiology Relative Value Scale. An RVU workload was calculated by multiplying the number of times each procedure was performed by the procedure's corresponding RVU; the sum of these products gave the overall professional RVU workload. Five productivity indexes were calculated. The physician index denotes the ratio of the total number of physicians in the clinics to the total number of radiologists. The availability index denotes the fraction of radiologists who are available to perform clinical work after deductions are made for time away from clinical work. The difficulty index measures, in RVUs per examination, the level of complexity of the overall examination mix. The examination index measures examinations per available radiologist, and the RVU index measures RVUs per available radiologist. Altogether, the 19 clinics reported 3,234,451 examinations performed by 299 radiologists. The computed overall indexes were as follows: physician index = 20 physicians per radiologist; availability index = 0.77; difficulty index = 2.27 RVUs per examination; examination index = 14,098 examinations per year per available radiologist; RVU index = 32,065 RVUs per year per available radiologist. When the clinics were grouped according to characteristics of the practices, the RVU index was higher for single-site practices, high-prepaid practices, outpatient-only practices, and practices without radiology training programs. Fifty-two percent of the RVUs were in general radiology, 37% in sectional imaging, and 10% in special procedures. The concept of RVU workload is timely because it undoubtedly will be used to compare workloads across medical subspecialties, and these workloads are likely to be related by third-party payers to compensation.     

Medical student radiology teaching in Australia and New Zealand

This study, involving 19 centres, establishes the status of medical student radiology teaching in Australia and New Zealand. It aims to document the academic and clinical staff profile involved in teaching, to indicate the methods of instructions used, to outline the available radiology library resources for medical students, to list the textbooks used in teaching and to uncover how many radiology departments are involving medical students in research. The findings can be used to plan and execute further actions that will enhance radiology teaching of medical students.     

Productivity of radiologists in 1997: estimates based on analysis of resource-based relative value units

OBJECTIVE: Productivity of radiologists was quantified using the resource-based relative value scale for examining trends in workload. MATERIALS AND METHODS: Staffing and workload data for 1997 were collected in a survey of radiology departments in multispecialty clinics. Workload ratios were calculated and were compared with prior surveys of the same clinics and with published data. RESULTS: Fifteen clinics reported 3,234,730 examinations and 1,860,729 resource-based relative value units (RBRVUs) performed by 284 radiologists and 28 fellows serving 6305 providers. Productivity ratios were as follows: physician index, 19 physicians per radiologist; provider index, 23 providers per radiologist; availability index, 0.78; difficulty index, 0.54 RBRVUs per examination; examination index, 11,559 examinations per year per radiologist; RBRVU index, 6090 RBRVUs per year per radiologist. Each index had roughly a twofold range of variation from lowest to highest ratio observed. Among diagnostic and interventional procedures, 37% of the supervision and interpretation RBRVUs were in general radiography, 41% in sectional imaging, and 22% in special procedures. Since 1973, the percentages of sectional imaging and special procedure examinations and RBRVUs have increased, and the difficulty index has increased. The physician index has been relatively stable. Non-supervision and interpretation codes constitute approximately 18% of the reported RBRVUs. RBRVU valuation of total radiology services has held steady or slightly increased between 1993 and 1997. CONCLUSION: RBRVU workload of radiologists in the clinics appears to be increasing primarily because of an increase in the percentages of highly valued sectional imaging and interventional and angiographic studies, which constituted 63% of the diagnostic imaging RBRVU workload. The ranges of the indexes among the clinics varies greatly.     

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards

RATIONALE AND OBJECTIVES: The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS: Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS: Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION: Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.     

Trends in on-call workload in an academic medical center radiology department 1998-20021

RATIONALE AND OBJECTIVES: The workload in radiology departments is increasing rapidly. This study was designed to determine whether and to what extent the workload is being generated outside of traditional working hours (defined as 0800-1700 Monday thru Friday, excluding holidays). MATERIALS AND METHODS: Exam statistics were derived from the radiology department's automated examination scheduling and reporting system for four successive fiscal years. The distribution of the number of studies completed throughout the 24-hour day and the 7-day week was charted. RESULTS: A large proportion of studies are being completed outside of traditional working hours. Moreover, as the overall workload of the department increased, the proportion of studies being completed during nontraditional working hours was increasing at an even faster pace, particularly in the cross-sectional imaging modalities. Computed tomography, magnetic resonance imaging, and ultrasound have increased by 59%, 51%, and 30%, respectively, over 4 years. The on-call proportions have increased from 34% to 40% and 13% to 18% for computed tomography and ultrasound, respectively, over 4 years and from 44% to 50% for magnetic resonance imaging over 3 years. CONCLUSION: These trends have implications for radiologist and radiology technologist staffing. The department has already modified the scheduling of technologist staffing to provide in-house extended-hours coverage in most modalities. As the number of studies conducted outside of traditional working hours continues to expand and the demand for contemporaneous readings increases, radiologist staffing may need to be adjusted as well. Traditional on-call coverage may be insufficient to competently handle the growing workload. This may have particular implications for radiology residency programs.     

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Operational and Educational Implications

The numbers of nurse practitioners (NPs) and physician assistants (PAs) are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. The use of radiologist assistants is growing in some radiology practices as well. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside radiology departments warrants closer review, particularly with regard to their potential influence on radiology education and medical imaging resource utilization. In this article (the second in a two-part series), the authors review recent literature and offer recommendations for radiology practices regarding the impact NPs, PAs, and radiologist assistants may have on interventional and diagnostic radiology practices. Their potential impact on medical education is also discussed. Finally, staffing for radiology departments, as a result of an enlarging nonradiology NP and PA workforce ordering diagnostic imaging, is considered.     

Radiology groups' workload in relative value units and factors affecting it

PURPOSE: To measure diagnostic radiology groups' workload in physician work relative value units (RVUs) and identify factors affecting it. MATERIALS AND METHODS: In 1996 and 1997, the authors surveyed diagnostic radiology and radiation oncology groups regarding finances, workload, and basic characteristics. The study was based on approximately 100 diagnostic radiology groups. The authors analyzed the distribution of workload in different categories of groups, conducting multiple statistical analyses. RESULTS: The annual numbers of procedures were approximately 10%-15% lower than those in a comparison survey with a good response rate. The annual number of RVUs per full-time equivalent (FTE) diagnostic radiologist was highly variable in every group category, as was the number of RVUs per clinical work hour. Multivariate regression analysis indicated that variation in the annual number of hours worked did not explain variation in annual workload. RVUs per FTE radiologist were higher the greater the percentage of a group's workload from interventional, computed tomographic, and magnetic resonance imaging procedures. CONCLUSION: Given the likely response bias, the annual workload per FTE radiologist probably averaged approximately 4,000 RVUs in academic groups and approximately 6,000 in nonacademic groups, but the large, unexplained variance means the average values should not be taken as norms.     

Radiology teaching: essentials of a quality teaching programme

Medical student teaching is an important component of radiology education. Despite the practice of radiology undergoing significant changes during the last two or three decades, the importance of radiology has not translated fully into medical school curricula in Australia and New Zealand. This article reviews the essential components of a quality medical student teaching programme.     

Breast radiotherapy: an Australasian survey of current treatment techniques

Prior to the dissemination of evidence-based quality assurance guidelines, the Australian National Breast Cancer Centre Radiation Oncology Group conducted a process survey of breast radiotherapy treatment delivery throughout Australia. A process survey was conducted in August/September 1998. This survey comprised questions enquiring about treatment positioning, immobilization devices used, planning strategies, simulation and dose computation methods, treatment prescribing and quality assurance. The survey was sent to 123 Australian fellows of the Royal Australian and New Zealand College of Radiologists (RANZCR) and to the six directors of New Zealand radiation oncology departments. Fifty-eight questionnaires were returned of which 38 were received from individuals and 20 represented a reply from a department with a routine breast radiotherapy protocol (representing an average of 4.5 radiation oncologists per reply). The study identified great consistency between departments with respect to dose and fractionation for breast tangents. The study also identified some areas of treatment planning and delivery that varied between individuals or departments. These mainly reflected a lack of evidence in some areas of radiotherapy treatment delivery. The circulation of quality assurance guidelines will perhaps improve consistency of radiotherapy techniques in which studies have identified that technique changes improve outcome. This study identified that these areas include the taking of simulation and port films and the use of off-axis dosimetry. Further studies are required for areas of radiotherapy treatment delivery that have little evidence for or against their implementation.     

Measuring the academic radiologist's clinical productivity: applying RVU adjustment factors

RATIONALE AND OBJECTIVES: To improve understanding of academic radiologists' clinical workloads, the Society of Chairmen of Academic Radiology Departments (SCARD) performed surveys to collect workload data for radiologists in 20 departments; workload was measured in relative value units (RVUs) per full-time equivalent (FTE). Although they were useful for comparisons within some subspecialties, the workload data proved inadequate for comparisons across sections, and adjustment factors were needed for each Current Procedure Terminology (CPT) code. MATERIALS AND METHODS: All CPT codes for examinations were divided into groups with similar radiologist work effort. Focusing on radiologists who worked almost exclusively in each group, the authors created adjustment factors by using data from the individual radiologists at each institution. RESULTS: The adjustment factors are 0.50 for angiography, 0.58 for computed tomography and magnetic resonance imaging, and 1.0 for nuclear medicine, plain radiography, and special procedures (no adjustment needed for these groups). These factors are multiplied by the work RVUs for each examination to create the adjusted workload RVUs. CONCLUSION: The SCARD survey provided very useful clinical workload data, with workload measured in work RVUs per FTE for specific subspecialty sections. The new adjusted workload RVUs allow comparison of radiologists' workload across subspecialties.     

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Regulatory,Billing, and Compliance Perspectives

The numbers of nurse practitioners and physician assistants are increasing throughout the entire health care enterprise, and a similar expansion continues within radiology. Some practices have instead embraced radiologist assistants. The increased volume of services rendered by this growing nonphysician provider subset of the health care workforce within and outside of radiology departments warrants closer review. The authors evaluate the recent literature and offer recommendations to radiology practices regarding both regulatory and scope-of-practice issues related to these professionals. Additionally, billing and compliance issues for care provided by nurse practitioners, physician assistants, and radiologist assistants are detailed. An analysis of the integration of these professionals into interventional and diagnostic radiology practices, as well as potential implications for medical education, is provided in the second part of this series.     

Radionuclide radiologist directed nuclear medicine services in district general hospitals in the South Thames Region

The equipment, staffing levels and imaging workload of all 14 radiologist directed nuclear medicine services in district general hospitals in the South Thames Region are presented. These are generally single camera departments providing a broad range of imaging procedures, including cardiac studies and white cell labelling, as well as the more usual renal, lung, thyroid and bone examinations. All departments have a high throughput, averaging 2358 examinations per year. Departmental staffing levels are variable, with some institutions having inadequate consultant radiology sessions free of other commitments as well as inadequate physics support. Potentially, these are important quality and legal issues that departments may need to address with hospital Trusts and Commissioning Agencies. Four small departments provided a service without any formally contracted radiologist sessions for nuclear medicine in the radiologists' job plans. The three medium sized departments have a closer match between sessions contracted and those actually worked, but in only one of these did the contracted sessional commitment equal the recommendation of the Nuclear Medicine Committee of the Royal College of Physicians. There is a disparity between the number of contracted consultant sessions and those actually worked in most institutions (86%), being at least two sessions in eight hospitals. Recommendations are made regarding the adequacy of some of the elements of provision in South Thames and the legal and safety implications for hospital Trust management and Commissioning Agencies.     

Delayed growth in the development of the radiologist assistant's role

The physician extender model has been established for many years (e.g., NP, PA) and radiology departments would benefit by fully adopting this model, as well, through the hiring of radiologist assistants (RAs). Potential benefits of this role are facility cost reductions and increased customer satisfaction. An RA is an advanced level radiologic technologist who works under the supervision of a radiologist to promote high standards of patient care by assisting radiologists in the diagnostic imaging environment. Agreements by stakeholders such as the ASRT, ARRT, and the ACR have to convene and regulatory hurdles involving the CMS have to be resolved in order for this physician extender position to thrive.     

Apprenticeship in radiology at the University Hospital Center in Grenoble: research on the most effective methods]

From analyses of strengths and weaknesses of the apprenticeship of radiology in France, of existing pedagogic methods, of time constraints within clinical settings and of scientific theories of teaching and learning, the authors define objectives that teaching should target and propose a new method of instruction problem and practise-based. The method appears applicable in French radiology departments. It should forster early acquisition by residents of professional attitudes and way of thinking, and make them active self-directed learners.     

Integration of the Community-Based Academic Radiologist With the Academic Radiology Department: A Strategic Imperative

Academic radiology departments are expanding into the community with deployment of community-based academic radiologists (CBARs). The remote practice locations, unique workplace challenges, and limited opportunities for meaningful collegial interactions can become drivers for radiologist isolation, dissatisfaction, and burnout. Integration of CBARs with the academic radiology department with which they are affiliated is a strategic imperative to mitigate radiologist isolation and potential burnout. Committed physician leadership by the academic radiology department can support integration. Strategies to strengthen integration include bidirectional clinical coverage systems, pairing new CBARs with established academic radiologist mentors at the academic center, encouraging CBARs to serve on academic committees and collaborate on research projects with radiologists at the academic center, and recognizing CBARs for their achievements in the areas of clinical productivity, practice development, community outreach, collegiality, and innovation.     

Preoperative staging of rectal cancer by MRI; results of a UK survey

AIM: To determine current day-to-day practice of and access to preoperative MRI for patients with rectal cancer in the UK, with the aim of identifying constraining factors. MATERIALS AND METHODS: A questionnaire asking for details of rectal cancer workload, multidisciplinary team (MDT) practice, preoperative MRI, the use of alternative imaging methods where appropriate, and an assessment of local access to MRI, was mailed to 283 UK departments of radiology. Replies were received from 142 departments (50.2% response rate). These were collated and response frequencies were determined. RESULTS: According to their replies, 135 (95%) of respondents always discussed rectal cancer cases within the context of an MDT, usually including a radiologist. Only 49% of respondents attempted to offer preoperative MRI to all rectal cancer patients, and 35% of respondents used MRI in less than 25% of cases. Of the 142 respondents, 73 (51%) felt their practice was currently constrained by lack of MR resources. The most frequently cited constraint was an available but over-subscribed MRI scanner. Limited radiology manpower was the next most frequently cited constraint. A significant minority stated that no MRI scanner was available. CONCLUSIONS: The MDT is a well established forum for the discussion of patients with rectal cancer, and a radiologist is usually involved. However, in the face of current guidelines, less than 50% of the units studied were able to offer preoperative MRI to all of their rectal cancer cases. Improved access to MRI and increased radiological manpower are necessary if current management guidelines are to be observed.