US Radiology Imaging and Workforce Volumes 2017-2024: An Analysis of 46.4 Million Imaging Examinations From 167 Radiology Facilities.

Abstract

To determine changes in site- and radiologist-specific imaging volumes before, during, and after the COVID-19 pandemic from a large, diverse sample of US radiology practices. Imaging volumes (46.4 million examinations) for 1,571 unique radiologists and 167 United States radiology practices in 19 states (academic [n ≤ 5], community hospital [n = 71], multispecialty clinic [n ≤ 5], freestanding imaging center [n = 86], other [n ≤ 5]) participating in the ACR General Radiography Improvement Database (part of the National Radiology Data Registry, which is a CMS-approved Qualified Clinical Data Registry) from December 1, 2017, to February 29, 2024, were analyzed. These dates included baseline, pandemic, and postpandemic periods. Six modalities were analyzed: CT, mammography, MRI, x-ray, ultrasound, and PET-CT. National Provider Identifiers (NPIs) were used to track individual radiologists. Changes in workforce number (by NPI), workload (examinations per day), NPI attrition, and NPI turnover were calculated by quarter. Of 1,571 radiologists, 671 (43%) worked full time and read ≥100 examinations per quarter throughout the baseline period and final study quarter. Mean aggregate change in examinations read per day per radiologist from baseline to study end was modest (+0.6% [49.1 per day to 49.4 per day]). However, the top quartile radiologists (by examination volume) experienced meaningful increases in examinations per day (+30.6%; 73.9 examinations per day versus 56.6 examinations per day [baseline]) and clinical days worked per quarter (+19.7%; 46.2 days per quarter versus 38.6 days per quarter [baseline]). The number of working radiologists increased 23.6% (1,094 versus 885 [baseline]) with substantial turnover. Days worked per radiologist per quarter remained similar (37.2 days versus 39.1 days, -4.9%). Sharp examination declines during the COVID-19 pandemic were not associated with large reductions in the radiologist workforce. Although the average radiologist read a similar number of examinations per day pre- versus postpandemic, the top quartile radiologists read 30.6% more examinations per day and work 19.7% more clinical shifts per quarter compared with the first quarter of 2018.