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The Job Market in Diagnostic Radiology 1999

Updated Findings from a Help Wanted Index of Job Advertisements

¹ Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., SP2-332, New Haven, CT 06520.
² Department of Diagnostic Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
³ Research Department, The American College of Radiology, 1891 Preston White Dr., Reston, VA 20191.

Received February 17, 2000; accepted after revision March 16, 2000.

 
Address correspondence to H. P. Forman.

Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
OBJECTIVE. The purpose of this article is to report 1999 data on the job market in diagnostic radiology detected using a help wanted index of job advertisements and to profile trends in practice type, location, and subspecialty using our previously published data as a basis for comparison.

MATERIALS AND METHODS. Each advertised job for a diagnostic radiologist in the American Journal of Roentgenology and Radiology between January 1991 and December 1999 was coded by practice type, location, and subspecialty.

RESULTS. In 1999, 3926 positions were advertised for diagnostic radiologists, representing a 75% increase from 1998. Private practice jobs, which represented 53% of advertisements from 1991 through 1994 and 64% of ads from 1995 through 1998, increased to 66% of ads in 1999. Geographic trends in 1999 were characterized by a relative increase of jobs in the Midwest and California and a decrease in percentage (but increase in total number of ads) in the Northeast and Southwest. The demand for subspecialists continued in 1999, with only 34% of ads placed for general radiologists. A relative increase in demand for neuroradiologists, mammographers, and abdominal imagers was also seen in 1999 in comparison with previously published data from 1995 through 1998.

CONCLUSION. The demand for diagnostic radiologists continues to rise, with more ads placed in 1999 than any other year from 1991 through 1998. Using a help wanted index of job advertisements, we have created an indicator of changes in the diagnostic radiology job market with specific reference to practice type, geographic location, and subspecialty training.

Introduction

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The demand for diagnostic radiologists has important implications both for trainees looking for jobs [1, 2] and for radiology practices planning future growth and hiring [3]. The past decade brought dramatic changes in the job market, retrospectively described by surveys of radiology practices [4, 5], recent graduates [6, 7], and residency program directors [6]. Major limitations of such studies include a significant lag between data collection, analysis, and dissemination; small sample sizes; and high cost.

Classified advertising indexes are useful in the study of global economies, labor markets, and real estate markets because they provide a concurrent, even leading, indication of market trends [8,9,10,11]. Therefore, to study trends in the radiology job market in a more timely manner and to forecast potential future supply and demand imbalances, we created a help wanted advertising index to monitor changes in the demand for diagnostic radiologists. We have previously reported our data from the first 8 years [12], 1991-1998, and now present our follow-up data for 1999.

Materials and Methods

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We present data in keeping with our previous article [12], updating through 1999. Because there have been no changes in our methodology, we only briefly review it here.

Each classified advertisement for a diagnostic radiologist appearing in Radiology and the American Journal of Roentgenology (AJR) from January 1991 through December 1999 was coded by type of practice (academic versus private), geographic location, and subspecialty. Though we use the term "ad" in this manuscript, ad refers to each advertised position because multiple positions may be advertised in a single classified advertisement.

Any private practice or partnership job was listed as such, despite any university affiliation. Otherwise, university affiliation with academic appointment was coded as academic.

Subspecialties included mammography; interventional, musculoskeletal, abdominal (including MR imaging, CT, and gastrointestinal radiology), pediatric, nuclear medicine, emergency and trauma, and chest radiology; neuroradiology; and general radiology.

Multiple positions in a single-print advertisement were coded separately. No attempt was made to screen for repeated ads. To remove a possible source of bias, even duplicate ads in the same issue were coded.

Geographic regions of the country used for coding are depicted in Figure 1. The northwest (NW) comprises six states: Alaska, Washington, Montana, Wyoming, Idaho, and Oregon. The southwest (SW) includes seven states: Nevada, Utah, Arizona, New Mexico, Texas, Hawaii, and Oklahoma. The Midwest (MW) included 13 states: North Dakota, South Dakota, Nebraska, Kansas, Missouri, Iowa, Minnesota, Wisconsin, Illinois, Indiana, Michigan, Ohio, and Colorado. The 10 Northeast (NE) states includes Pennsylvania, New York, New Jersey, Delaware, Connecticut, Vermont, New Hampshire, Maine, Rhode Island, and Massachusetts. The Southeast (SE) region includes 14 states: Maryland, Washington, DC., Virginia, West Virginia, Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Alabama, Misssissippi, Arkansas, Louisiana, and Florida. California is coded as a separate region.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Drawing shows labeled map of United States divided into geographic regions used for data collection. Note for data collection Alaska is included in Northwest and Hawaii in Southwest.

Results

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Seventeen thousand six hundred twenty-three positions were advertised for diagnostic radiologists from 1991 through 1999: 8435 from January 1991 through December 1994, 5262 from January 1995 through December 1998, and 3926 in 1999. The monthly nadir of 37 ads was seen in July 1995, and the peak was achieved in the penultimate month of data collection, November 1999 (Fig. 1). The highest annual total number of advertised positions was seen in 1999, with 3926 ads. The next highest was 2799 ads seen in 1991, the first year of data collection.

Forty-seven percent of positions advertised from January 1991 through December 1994 were for academic positions. Between January 1995 and December 1998, only 36% of positions were for academic positions, and this trend continued in 1999 with only 34% of ads representing academic positions (Fig. 2). Although the percentage of academic positions continues to decline, the absolute number of academic positions advertised reached an annual peak in 1999.

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Graph shows actual number of advertisements per month (bars) from January 1991 through December 1999 with 12-month rolling average () calculated to reduce seasonal variation.

A significant geographic trend of jobs away from California (8% and 6% of all advertised positions between January 1991 and December 1994 and between January 1995 and December 1998, respectively) reversed in 1999, in which 9% of ads represented jobs in California. Other trends include a continuing increase in ads for jobs in the Midwest, which accounted for 28% of ads in 1999 (up from 16% and 22% in the earlier and later periods, respectively), and relative decrease in positions in the Northeast (down to 23% from 27% in both of the earlier time periods) (Fig. 3 and Table 1). Again, in 1999 the absolute number of ads peaked in each of the eight geographic locations.

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —Graph shows number of advertisements for diagnostic radiologists by practice type ( = academic, = private) from January 1991 through December 1999.

Subspecialty trends in 1999 data show a significant increase in relative demand in mammography, which accounted for 11% of jobs in 1999 (up from 5% and 8%); neuroradiology at 10% in 1999 (up from 8% in both earlier time periods); body imaging, which accounted for 14.5% of jobs in 1999 (up from 13.7% and 10.2%); and a decrease in relative demand for general radiologists, which accounted for 34% of jobs in 1999 (43% and 41% in the earlier time periods). Relative demand for interventional, pediatric, chest, bone, and emergency radiology and nuclear medicine has not changed significantly since the January 1995-December 1998 data, but all fields, including general radiology, have increased in absolute number of advertisements (Fig. 4 and Table 2). Figure 5 shows the shift in distribution of subspecialty advertising.

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —Pie charts depict advertised positions by geographic location (1991-1994; 1995-1998; 1999). NE = Northeast, NW = Northwest, MW = Midwest, SE = Southeast, SW = Southwest, CA = California, CAN = Canada, INDET = indeterminate.

View larger version (30K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5. —Pie charts depict advertised positions by subspecialty (1991-1994; 1995-1998; 1999). V/I = interventional and vascular, Mammo. = mammography, Neuro. = neuroradiology, Ped. = pediatric radiology, Abd./X-Sec. = abdominal and cross-sectional imaging, M/S = musculoskeletal radiology, ER = emergency radiology, Nuclear = nuclear medicine, Gen. = general radiology.

Discussion

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Help wanted indexes have been used in many industries to provide an indication of market trends. Such models have been used for both economic forecasting and predicting supply and demand in the labor market [8,9,10,11, 13]. Although imperfect, they derive credibility from continued use over three decades and theoretic underpinnings including work by Nobel Prize—winning economist Robert M. Solow [8, 11].

Like all studies, ours has several potential limitations. Obviously, we have no information on jobs that were not advertised in the two journals studied. Also, our index may overrepresent hard-to-fill jobs because they may be advertised for more months than rapidly filled jobs. However, neither of these limitations should invalidate trends in the job market. Changes in advertising policy by either journal or a change in governmental regulation demanding advertising of particular positions could account for a shift in advertisement practices, but we find no evidence that such changes occurred during our period of data collection. Finally, as radiology jobs become generally more difficult to fill, which reportedly has happened in the last 1-2 years, employers will probably make more intensive use of all forms of advertising to fill openings. Thus the percentage increase in advertisements is likely to exaggerate the actual percentage increase in the number of available jobs.

Other potential limitations of our help wanted index is that many jobs in radiology are never advertised in either journal, academic centers may rely more on word of mouth to attract candidates, and practices may advertise through other media such as the American College of Radiology Web site or subspecialty-specific publications to publicize job opportunities. Conversely, an advertisement is no guarantee that a real position exists; an ad may be placed for a position already filled in another manner.

Over the past decade the practice of medicine has been dramatic changes. The increasing presence of health maintenance organizations, other forms of managed care, and a predicted surplus of subspecialty physicians by the Council of Graduate Medical Education stimulated much debate about the future of radiology. In the early 1990s, predictions of a dramatic decrease in the number of practicing radiologists by 29-50% were common [1, 14, 15]. In response, articles were published proposing means of limiting the supply of radiologists including decreasing the number of foreign medical graduates into training programs in the United States, decreasing the size of residency programs, and retraining existing practitioners in other areas of medicine [1, 14].

These issues emphasize the need for an accurate assessment of the demand for diagnostic radiologists. The American College of Radiology has published extensively about the job market in radiology, providing survey results and projections. Although accurate, their surveys are limited by a substantial delay between data collection and dissemination to trainees, practitioners, and policy makers. The data presented from a help wanted index of advertisements for diagnostic radiologists provides an accurate, coincident, and even leading indicator of market trends. We have previously reported the high correlation of our help wanted data with that of studies from the American College of Radiology [12].

Despite the bleak projections made earlier in the decade, for 1999 we report that there was a continuing strong increase in the demand for radiologists. There are several possible explanations for this observation. The current demand for diagnostic radiologists may reflect a rebound effect from the nadir in 1995 when few positions were advertised as predictions for a surplus of diagnostic radiologists loomed nearer. In other words, we hypothesize that in the early 1990s radiology groups became more conservative in hiring new members, fearing that the effects of changes in health care policy and reimbursement would result in a declining workload. Instead, workload increased in the middle of the decade [16], and radiologists grew tired of working harder without a concomitant increase in revenue. Therefore, the increase in advertised positions late in the decade reflect a hiring "catch-up" to fill the void created earlier in the decade when radiology groups overestimated the actual effects of managed care. Research by Sunshine et al. [16] compared the actual workload of radiologists in 1995-1996 with that in 1991-1992 and found individual radiologists had increased their average workload by more than 4.5%, and that each patient in the United States received 18% more radiology services from diagnostic radiologists in 1995-1996 than in 1991-1992.

Another theoretic effect of managed care that would account for increasing demand is an increase in retirement and early retirement of radiologists who are not willing to work in an environment of decreasing salaries and increasing competition for patients and health maintenance organization contracts. In fact, American College of Radiology studies have found a doubling of retirements from expected levels in 1996 and 1997, the most recent years studied [17].

The relative increase in demand for private practice positions advertised may also be explained by health care reform. In 1998 Chan et al. [18] described a survey of 3024 groups and found an "extensive move from groups with two radiologists to groups with three or four...and the number of groups with 15 radiologists or more also increased...[by]... one-third." In other words, as individual practices have expanded their coverage to include multiple hospitals and outpatient centers to compete for health maintenance organization contracts, they require more personnel to provide coverage. Whether this reflects an increase in non-partnership tract, part-time, and weekend positions would be an interesting area to study in the future.

Another factor that may contribute to the increased demand for radiologists, particularly private practice radiologists, is the pressure to provide 24-hr on-site coverage. Publications from 1998 in the radiology literature [19, 20] have shown that 24-hr on-site radiology coverage improves patient care. To maximize patient care and maintain control over techniques used emergently in after-hours work, such as the use of sonography by emergency department physicians and surgeons, both academic and private groups are increasing their on-site availablity. Academic practices, however, are generally larger, have trainees, and are more able to provide extended coverage with trainees, whereas private practices may require additional staff to provide additional coverage.

Advertised positions for general radiologists decreased as a percentage of the total in 1999 as the demand for neuroradiologists, mammographers, and body imagers increased. This is a very interesting finding at the end of a decade dominated by claims that the United States has an overspecialized physician workforce and an emphasis on more primary care practices. We believe that as medical knowledge has expanded over the last half century, any one individual can encompass less of the total, so the trend to subspecialization is natural and salutary. The free choices of radiology groups in their hiring practices seem to confirm this view. However, the increase in subspecialization may also be fueled by more subspecialties formalizing certificates of additional qualification and requirements to maintain proficiency, and by the trend to larger group size. It is easier to keep a subspecialist relatively busy with work in his or her subspecialty in a large group than in a small one.

References

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