Q&A: How the Economy, Reimbursement Policies and Teleradiology Have Affected the Job Market for Radiologists

When Merritt Hawkins published its 2018 Review of Physician and Advanced Practitioner Recruiting Incentives, it contained some exciting news for radiologists: after a rough few years earlier this decade, the radiology job market has climbed back with a vengeance. 

What led to this shift in demand? What does it mean for the specialty going forward? 

Travis Singleton, senior vice president of marketing and sales for Merritt Hawkins, spoke with imagingBiz about the past, present and future of the radiology job market. The full conversation is below:

Radiology was the most requested physician search assignment back in 2003, but it wasn’t even in the top 20 by 2012. Now, according to the 2018 Review of Physician and Advanced Practitioner Recruiting Incentives, it’s back at No. 4. Can you explain why demand for radiologist recruiting has been so up and down over the last 15 years?

It says quite a bit about radiology that it was the most requested search back in the early 2000s. For it to be at the top over such search assignments as family medicine or internal medicine—which are much larger in size than radiology and infused in every part of our healthcare system—that says a lot right there. For radiology to even get to that height is impressive. 

But after that peak, it was hit with a rough one-two punch followed by a haymaker. First, a generation of medical students who wanted top-end earning potential and flexible schedules came up at the same time, and radiology filled both of those needs perfectly, making the specialty more in-demand than ever. 

Then, radiology became one of the first specialties to get a specific reimbursement cut, which hurt utilization. So you had more people going into radiology, policies impacting how radiologists were reimbursed, and finallykeeping with the boxing analogyradiologists were hit with a haymaker in the form of the 2007 recession. Radiology was impacted especially hard by the recession, specifically the suppressed number of elective procedures. The end result was that radiology got knocked down the list of most requested search assignments. 

But we knew, because so many other specialties and channels depend on imaging, that radiology would bounce back. And as the country started to claw back from that recession, you saw patients go back and take care of procedures they had put off at first—and that really helped the specialty recover. 

How has growth in teleradiology impacted demand for radiologist recruiting? 

Well, around 2010 or so was when we really saw teleradiology start to become pervasive. That’s important, because it changed the spectrum of the specialty of radiology. Patients started becoming more informed about teleradiology and more accepting of teleradiology. Physicians and physician groups were no longer fighting teleradiology—in fact, they started embracing teleradiology. And once the technology became affordable and generally accepted in all delivery systems, teleradiology really started to take off. And that added gas to the fire that was already lit, if you will. Teleradiology taking off at that point really helped push radiology back to where it was as far as demand is concerned.

Do you have any predictions for where radiology may land in next year’s rankings?

Well, the need for radiology is going to continue to escalate. Where it actually falls in our rankings will have more to do with other specialties than radiology itself, because I think radiology’s path is somewhat forged. 

If you really try to understand what the government has been doing to our healthcare system—which is difficult these days—you see that there was this move to preventive care, to primary care controlling the continuum of care, to reducing back-end utilization. Now, six or seven years into that shift, you see that it didn’t quite work out how the government hoped. No matter what, our bodies are going to break down. Could you stave off cancer or the devastating effects of cancer for a few years? Sure. Can you avoid those things altogether? No. 

Even if that move had worked perfectly, people underestimated the role of imaging. The push to preventive care increased the need for radiology instead of decreasing it. And improvements in technology are also increasing the need for radiology. There’s a fear of artificial intelligence right now, for example, but better technology playing a bigger role tends to increase the need for a specialty, and ultimately the need for more radiologists. 

I just don’t see how you paint a future without radiology being prevalent. 

According to that same Merritt Hawkins report, there is an ongoing trend toward more frequent physician placement in urban settings. What does this mean for employers and for radiologist job seekers?

If you’re an employer in a rural area and you need to hire a radiologist, you should be concerned. You should be scared. In the past, rural areas could bring in people by offering loan forgiveness, a higher guaranteed salary, requiring less time to get a partnership, those kind of things. Now, though, downtown Chicago is competing just as hot and heavy as Poughkeepsie. Everybody is offering loan forgiveness, everyone is offering a higher guaranteed salary. 

Also, these larger health systems are better suited to absorb radiologists than smaller systems and smaller hospitals. With flexible schedules and more subspecialty work it has leveled the playing field, which makes it much more difficult for providers in rural areas. 

For job seekers, if you are a radiologist, you should be in a very happy place. 

How has the market responded to teleradiology? Do providers seem more likely to use teleradiology services than, say, a few years ago?

Telehealth in general is a really fragmented market, but teleradiology is kind of its own thing. It’s a more mature market. It’s also a very competitive space. But I continue to see a lot of acceptance of teleradiology, and that has changed over time. There are clients who didn’t trust it at first, but then they started using it for emergencies … then they started using it for nighthawk reads … then they started using it for general reads … and now they are using it for specialty reads. So as that continues to happen, it’s going to build up trust in teleradiology, and demand, across the board.