Building the Pipeline
By Josh Hildebrand
Radiology Today
Vol. 24 No. 8 P. 14
In May 2022, RSNA published an article about the global shortage of radiologists, citing numerous issues those within the field are facing. Issues such as the impact of the COVID-19 pandemic on workload and morale, an aging population, and a lack of available radiology residencies for trainees and students in medical school perpetuate burnout and overall dissatisfaction.1
Another article, published in January of this year, reached similar conclusions, adding that radiologists are disproportionately affected by these problems. Because 82% of radiologists are aged 45 and older and 53% are aged 55 and older, these issues are leading to an increased likelihood of retirement, creating additional problems as older radiologists retire faster than their roles can be filled. Worse still, filling those roles has become more difficult due to a lack of “accurate perceptions of what the job is” among medical students and other factors.2,3
“Radiology is at times an invisible specialty,” says Carina Yang, MD, an associate professor of radiology and vice chair of diversity and inclusion in the department of radiology at University of Chicago Medicine. “We need to change misperceptions of the importance of our contribution to clinical care.”
Various solutions have been suggested to address these problems, including adopting AI and machine learning technologies, increasing trainee positions within the field, and improving outreach to medical students. While these solutions sound feasible, a bit of digging reveals that the problem is complex.
What Is the Pipeline?
This year’s annual Society for Imaging Informatics in Medicine meeting concluded with a presentation from Teri Sippel Schmidt, an adjunct professor at Marquette University in Milwaukee and Johns Hopkins School of Medicine in Baltimore. Sippel Schmidt’s presentation focused on increasing interest in medical imaging and informatics, which, much like radiology, are facing shortages that are projected to worsen.
A phrase that has been circulating within the imaging and informatics field is “building the pipeline.” During her presentation, Sippel Schmidt made several references to this phrase, but what does it mean? Much like a real pipeline, the medical imaging pipeline functions to push students along, ensuring that young people are simultaneously made aware of the field and attracted to it. On paper, the process may sound easy, but, as discussed during the presentation, it involves multiple crucial steps to ensure that the field maintains operations and runs smoothly as younger people are recruited.
It has become apparent, now more than ever, that young students are not finding interest in STEM fields. A study conducted by Lego in collaboration with The Harris Poll found that while children aged 8 to 12 are interested in space exploration, they were three times more likely to aspire to being a YouTuber than an astronaut.4 Younger generations being less interested in STEM presents numerous dangers for the future. The medical imaging field is in dire need of new life and energy, according to Sippel Schmidt, but filling vacancies and attracting new talent in various specializations is proving difficult.5
“We need to pique student interest and draw them into [health care] fields,” Sippel Schmidt says. “Gen Z is looking for meaningful life’s work; in health care, we have the special sauce that can lead to people clearly helping others in a meaningful way. We need to make that clear.”
Gender Gap
It’s well known that women are underrepresented in radiology. Despite making up more than one-half of all medical students in the United States, according to data from 2020, women represent only 27% of first-year radiology residents.6 While this number doesn’t necessarily reflect the number of women entering the field of medical imaging and informatics, it is still important to note that this “gender divide” already exists within radiology, and the problem starts long before women are ready to enter the field.
A study mentioned during Sippel Schmidt’s presentation, conducted in 2018 by Microsoft and Shalini Kesar, an associate professor of information systems at Southern Utah University, sought to quantify and understand why young female students are losing interest in STEM careers. The research revealed several factors contributing to their lack of interest in STEM.7 These factors include the following:
1 Lack of role models. Data reveal that girls cannot picture themselves in STEM roles if they do not have female role models within the field. This problem is exacerbated by lack of exposure to STEM careers.
2 Uncertainty about real-world application. Girls’ perception of STEM roles typically centers on a lack of creativity or positive impact on the world, which leads to hesitation in pursuing a field in which they perceive they will fail to make positive change.
3 Few opportunities for hands-on learning. STEM clubs and other similar activities provide numerous glances into the field. However, without such clubs, girls are much less likely to pursue the field, again, due to lack of exposure.
4 Not enough encouragement. When encouragement from parents or teachers is lacking, girls’ interest in STEM roles diminishes. This coincides with the necessity to cultivate a “growth mindset” where failing is a means to encourage further effort and exploration, which mimics many processes in STEM careers.
“Waiting to expose girls—and really anyone—to health care and informatics in college is way too late,” Sippel Schmidt says. “Educators need to expose students to the basics of ... radiology ... and of all the other fascinating medical fields. The entire industry will benefit from this.”
Challenges Ahead
“Acute workforce shortages for radiologists challenge maintaining levels of care,” says Geraldine McGinty, MD, a professor of clinical radiology and population health sciences at Weill Cornell Medicine in New York.
Workforce shortages in medical practices can manifest in the form of physician stress, physiological deterioration, and a higher risk of staff injuries.8 Having tired and overworked physicians also increases the probability of medical errors and can lead to reduced staff retention.9 All of those factors can negatively affect patients and quality of care. Complications in health outcomes compounded by increased wait times and an overall decrease in efficiency can become commonplace, leading to higher mortality rates.
Data show that in the United States, congested emergency departments lead to delays in treatments and a poorer quality of care. Perotte et al found that turnaround time for CT scans in overcrowded conditions was 5.9 hours, compared with typical working conditions, which can speculatively take no more than one hour.10,11
In the United Kingdom, two reports conducted by the Royal College of Radiologists found that cancer patient outcomes are significantly worse due to shortages of oncologists and radiologists.9 The result is a 10% increase in risk of death for every month that cancer treatment is delayed, an ordinary occurrence due to workforce shortages. The problems compound further when an already burnt-out workforce takes on more to compensate for the lack of help.
Possible Solutions
Melissa B. Pergola, EdD, RT(R)(M), CEO and executive director of the American Society of Radiologic Technologists (ASRT) and CEO of the ASRT Foundation, says that organizations should consider what is in the best interest of their employees, determining what they need and how best to address the issues they are facing.
“The ASRT and the American Registry of Radiologic Technologists and Joint Review Committee on Education in Radiologic Technology is hosting a Consensus Committee on the future of medical imaging and radiation therapy in early 2024,” she says. “They will investigate the rationale for the workforce shortages, its impact on the profession, and make recommendations for specific actions to take to address these shortages without compromising the future of the profession.”
Of course, there are technological solutions to workforce shortages, as well. Recently, AI has been incessantly covered in the news and is being studied and tested across various fields of health care, especially in radiology. Some preliminary data suggest that AI reduces read times and makes detecting abnormalities in images easier.12
McGinty, who practices as a breast imaging radiologist, says the field should embrace these technological advances to combat shortages and provide better care for everyone.
“We need to continue to advance technology to augment the capacity and capability of our technologist workforce,” she says. “I’m excited about the avenues for innovation. New technologies [such as] AI [need] rigorous assessment and development by diverse teams who are committed to health equity.”
Expanding the Pipeline
Introducing young students to STEM roles is one fundamental way of expanding the pipeline and infusing new life and energy into various fields. This is generally true of both female and male students, but evidence suggests that female students need more encouragement to envision themselves in such roles.
Part of Sippel Schmidt’s work at Marquette involves acting as the faculty liaison for its Society of Women in Engineering group, which has formed a relationship with a local middle school to introduce girls to STEM projects highlighting various aspects of engineering. Providing this “hands-on” experience not only leaves a lasting impression on the students and gets them interested in STEM but also gives employees within the field an opportunity to share what they do and make a difference.
“We have done projects from soil and solar ovens to radiology images and EKG cardiology monitoring,” Sippel Schmidt says. “Helping to open the eyes and provide mentors for very young students [shows] the possibilities in health care and STEM. Just help your little corner of the world; the reward is two-fold.”
All of this isn’t to say that college and medical students will stumble upon the imaging field. Ensuring college students have access to imaging and informatics resources is equally as vital, a point emphasized by Yang. “Medical school students have little exposure to the field of radiology,” she says, which creates gaps in knowledge and leaves vacancies within the field unfilled. The field’s expansiveness offers students a wide range of paths to explore, from radiology technologists and nursing roles to medical imaging professionals. The choice is up to them.
“Raising awareness is critically important,” McGinty says. “The breadth of careers within radiology [provide] ample opportunities to remain connected with patients, perform both diagnostic and therapeutic procedures, and advance medicine as a whole through research.”
Diversity as Strength
Having a diverse workforce ensures not only that the population has access to a wider range of care, with knowledge from differing life experiences and backgrounds, but also that minorities and other underrepresented groups have a voice where it matters most: their health care.
“A diverse workforce is crucial to support our diverse population of patients in the United States,” Pergola says. “Having a diverse workforce also drives creativity and innovation in the field and leads to higher quality of and access to care.”
Thanks to dedicated people within the field, especially those who are women, there now exist a plethora of groups and programs that stand up for equality of care and representation and promote excellence within the field. The ASRT has an expansive list of programs which includes the following:
- the ASRT Student to Leadership Development Program;
- the Diversity Leadership Development Program (relaunching in 2024); and
- various philanthropic efforts by the ASRT Foundation to provide scholarships and opportunities for minorities and underserved communities.
Naturally, the ASRT is only one of many organizations with efforts to bolster diversity and equality. Under Yang’s guidance, the University of Chicago initiated a new Women in Radiology program, which provides “more formal educational and social opportunities for clinical female faculty and trainees.” The program supports early-career female radiologists and plans to add programming that will provide CV writing support and other academic and professional resources.
The lack of diversity within radiology motivated McGinty to found RadEqual (formerly Radxx) with the expressed purpose of bringing more representation of women in the field. RadEqual offers a community with “very low barriers to entry” that “bridge the radiologist and technologist/engineer/administrative communities.” RadEqual highlights “champions and rising stars” within the field, furthering the group’s values and goals of inclusivity and equality.
There is still plenty of important work to be done. Making sure young students are exposed to STEM early in their educational journeys is critical. Demonstrating to medical students the various paths and specializations that exist within the field of imaging and informatics keeps the “pipeline” working smoothly, encouraging new ways of thinking and innovation while addressing workforce shortages.
It’s important to think of diversity as “more than a metric;” it is what strengthens society.13
“User Centered Design principles include getting perspective and input from different users to ensure the most comprehensive and thorough design,” Sippel Schmidt says. “Radiology and imaging are no different. Diversity is critical ... considering input from different genders, socio-economic backgrounds, ethnicities, etc. They are all important and valuable perspectives that lead to better solutions.”
— Josh Hildebrand is the assistant editor of Radiology Today.
References
1. Radiology facing a global shortage. RSNA website. https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage. Published May 10, 2022.
2. Radiology department staff shortage: key contributing factors and how to address them. Gemseek website. https://gemseek.com/blog/healthcare/radiology-staff-shortage/. Published January 12, 2023.
3. Radiologist staffing trends 2021. vRad website. https://blog.vrad.com/radiologist-staffing-trends-2021. Published February 18, 2021.
4. Kids now dream of being professional YouTubers rather than astronauts, study finds. CNBC website. https://www.cnbc.com/2019/07/19/more-children-dream-of-being-youtubers-than-astronauts-lego-says.html. Published July 19, 2019.
5. Radiologist shortage: strategic solutions for healthcare facilities. RamSoft website. https://www.ramsoft.com/radiologist-shortage/. Published August 16, 2023.
6. Too few women in the field of radiology. RSNA website. https://www.rsna.org/news/2023/april/increasing-number-of-female-radiologists. Published April 26, 2023.
7. Microsoft. Closing the STEM gap. https://query.prod.cms.rt.microsoft.com/cms/api/am/binary/RE1UMWz. Published March 2018.
8. Preparing for a radiologist shortage. Jackson + Coker website. https://jacksoncoker.com/radiologist-shortage/. Published July 7, 2022.
9. New reports show staff shortages continue to hold back cancer care. Cancer Research UK website. https://news.cancerresearchuk.org/2022/06/09/new-reports-show-staff-shortages-continue-to-hold-back-cancer-care/. Published June 9, 2022.
10. Perotte R, Lewin GO, Tambe U, et al. Improving emergency department flow: reducing turnaround time for emergent CT scans. AMIA Annu Symp Proc. 2018:897-906.
11. CT scan (computed tomography): what is it, preparation & test details. Cleveland Clinic website. https://my.clevelandclinic.org/health/diagnostics/4808-ct-computed-tomography-scan. Published 2020.
12. Hyun Joo Shin, Han K, Ryu L, Min Jung Kim. The impact of artificial intelligence on the reading times of radiologists for chest radiographs. NPJ Digital Medicine. 2023;6(1).
13. Kubik-Huch RA, Vilgrain V, Krestin GP, et al. Women in radiology: gender diversity is not a metric-it is a tool for excellence. Eur Radiol. 2020;30(3):1644-1652.
